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health tourism in Himachal Pradesh project research report

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  • 1. Research Report 31 May 2012 On Health Tourism in Himachal PradeshSubmitted To: Submitted By:Prof. S. P. Bansal Naveen VermaDirector MTA 4th SamIVS, MTA, H. P. University Exam No: 1579 Roll No: 443 2012 Institute of Vocational (Tourism) Studies Masters of Tourism Administration Himachal Pradesh University Summer hill, Shimla- 171005
  • 2. ACKNOWLEDGEMENT First of all I am thankful to almighty God for his divine bless ingand love. Its my pleasure to acknowledge indebtedness and heartfelt thanks toProf. (Dr.) S .P. BANSAL, Director (M.T.A), Institute Of VocationalStudies, for his great effort to make us experience and work-on for areport on : “HEALTH TOURISM IN HIMACHAL PRADESH”I would also like to mention the invaluable support of our respectableteachers:Dr. Chander Mohan, Dr. Shushma Rewal Chug, for there great guidanceand favorable support. I would also like to thanks other teachers Dr. JaswinderSharma of the department who helped me during the preparation of thisresearch.Date: 31/05/12 Naveen VermaPlace: HPU - Shimla 2
  • 3. ContentsS. No. Particulars Page No. a Acknowledgement 2 b Contents 3 c Preface 4 Part – I Health Tourism 1 Introduction to Health tourism 6 2 Concept of Healthy Living and Healthy Lifestyle 7 3 What We Can Do for a Healthy Living 7 4 Health Spas and Massage - Health Tourism 23 5 India Health Spas 25 6 Types of Massages for Health Tourism 27 7 Medical Tourism as a part of Health Tourism 42 8 Risks of Medical Tourism 44 9 Benefits of Medical Tourism 45 10 Medical Tourism in India 47 11 Alternative Medicine Treatments 48 12 Alternative Medicine treatments in India 65 13 Health Tourism in India 66 14 Ayurveda & Health Tourism 68 15 Herbal Medicine & Health Tourism 69 16 Yoga & Health Tourism 70 17 Meditation, Meditation Retreats & Health Tourism 71 Part – II Case Study / Research 18 Research Design 73 19 Research Methodology 75 20 Case Study in Health Tourism 81 21 Designing the Health Product 90 22 Developing and Positioning of Health Tourism Product 93 23 Major players in Health Tourism 95 24 Survey 99 Part – III Health Tourism in Himachal Pradesh 25 About Himachal Pradesh 111 26 Health Tourism in Himachal Pradesh 114 27 A Case study on a Health Project in Himachal Pradesh 118 28 Health Tourism in Himachal Pradesh – SWOT Analysis 120 29 Resources available at Himachal Pradesh for Tourism 121 30 Recommendations 122 31 Conclusions 127 32 Questionnaire Format 128 33 References 131 3
  • 4. PrefaceFor centuries health has been one of the main motivations for travel. Travelling for achange of weather so as to improve or to rebuild ones’ strength/health has always existed. History traces it long back, though special places or destination for building healthcan be positively established since Roman era. The Roman Empire constructed ‘baths’popularly known as ‘spas’ where various health-related services like massage, sauna, etc.were provided to visitors. Ordinarily, these spas were believed to be the resting place ofdivine nymph and it was believed that when a visitor used to take a dip in the holy waterbelieved to have developed symbolic relationship with them. Later on, a city ‘Bath’ inEngland became very famous as a destination for health tourists. This city boasted ofbaths either built by Romans or constructed on the lines of Roman baths. In modernworld, health has become very precious. Feeling and looking healthy seems to be themantra for today’s fast moving generation. Consequently, many health related travelservices have come up who looks after both the physical and spiritual well being of thetour package buyer. The customer/buyer/client/traveller has the choice of picking toursfrom various spas, health clubs, ayurvedic, yoga and spiritual centres. These are gainingpopularity among corporate traveller who spends quite a lot of time away from home onbusiness trips.This report is divided into three parts, Part I, II & III.In Part – I, prime focus is upon the concept of health and health tourism. I have tried todescribe various forms/activities of health sector and its link to tourism along with therecurrent status in India.In Part – II, with the help of small case study, I have tried to define and describe thevarious forms of Health Tourism, design and develop a health tourism product, andcomprehend the future scope and prospect of health tourism.In Part – III, I have tried to express Himachal as a Health tourism destination, along withconclusion and recommendations. 4
  • 5. Part – IIntroduction to Health Tourism 5
  • 6. 1. INTRODUCTIONDefinition of Health TourismHealth tourism or medical tourism is a particular process of traveling different parts of theworld to avail advanced Health & Medical care other treatment by highly experienced aswell as professional surgeons at any of the advanced and state-of-the-art medicalinstitutes of the world. Health tourism can be described in various ways that are alsoknown as health travel, medical travel, medical value travel, medical overseas, surgeryoverseas, medical outsourcing, health care abroad, offshore medical and many more. As more people around the world take an active interest in their health, a travelsegment known as health tourism has evolved to fill customer needs. Not to be confusedwith medical tourism, which focuses more on surgical procedures, health tourism is amuch broader concept which include medical but primarily centered around resortsdesigned to pamper or improve the body and relax the mind. Hundreds of health resorts and spas exist around the world, offering specializedbeauty and fitness services, and extended programs to improve your health. These resortsare almost always located in stunning natural environments or in the trendiest citydistricts. Spas play a major role in health tourism, but this field also extends into areaslike addiction treatment and weight loss. Destination spas and health resorts are the most common and popular health travelvenue. They offer a comprehensive range of services, from massage and Ayurvedictherapy to yoga and outdoor recreation facilities. The goal of these resorts is to sendtheir guests home feeling happier, healthier, fitter and more relaxed. Everything iscontained within the health spa resort, allowing guests to relax and focus on themselves. Spa resorts often specialize in a particular health remedies. Mineral baths havebeen around for thousands of years, and countries like Bulgaria and New Zealandcapitalize on these natural geothermal properties. Mud baths and other natural health 6
  • 7. cures are usually accompanied by a full menu of pampering services like massage andfacials at these facilities. More holistic resorts offer treatments like acupuncture, coloniccleansing, hypnotherapy and meditation. There are also specialized health centers for issues such as weight loss. Theseresorts place an emphasis on losing weight and improving eating habits. Guests typicallyfollow a schedule lasting from a few days to a week or more. The meals are speciallytailored to boost health and guests attend workshops to learn more about staying fit,eating right and keeping their weight down. Another common specialized health destination is for addicts. Alcohol and drugaddiction are the two most common problems dealt with at these facilities. They are setup like all-inclusive resort centers, except that there is more emphasis on monitoring theguests’ behavior and keeping them on their rigid programs. These are not particularlyrelaxing resorts, but they can often break a person’s addiction in a healthy manner. Fitness holidays are gaining popularity with travelers who want to get some well-needed exercise while on vacation. This is the broadest category of health tourism,because the location is more important than the venue. Mountain resorts provide skiingin the winter and hiking and biking in the summer. Beach resorts are also popular forswimming and water sports. A fitness holiday places the impetus of action entirely on thetraveler, and there are resorts at virtually every popular outdoor destination on the planet. 7
  • 8. 2. Concept of Healthy Living and Healthy Lifestyle Before discussing about Health Tourism, it should be clear to one about theconcept of Health. There are many factors that affect our health. While some cannot becontrol (such as genetics and age), there are many other factors that are under yourcontrol. Not only will leading a healthy lifestyle improve our health, wellbeing andhappiness, studies have also shown that some of the leading causes of death such as heartdisease, stroke, cancer and other serious diseases can be prevented by improving personalhealth habits. A healthy lifestyle can also reduce recovery times, make a person lookhealthier and younger and provide more energy. Eating right, staying physically active, reducing stress and avoiding or moderatingharmful addictions such as smoking and drinking are the basis of a healthy life.3. What We Can Do for a Healthy Living: Healthy living must take into consideration the needs of the individual sincedespite similarities in our physiology, every human being has unique physicalrequirements that are dependant on factors such as age, weight, physical and mentalactivity and any physiological peculiarities that our bodies develop or are born with. 8
  • 9. There are, however, general guidelines that the medical community is in agreement onand it’s from these guidelines that tip for living a healthy life can be established. 1. Healthy Diet: Eat a balanced diet including a variety of healthy foods and limit calories and saturated fats. 2. Health Fitness: Be physically active 3. Weight Loss: Maintain a healthy weight 4. Healthy Sleep: All living beings require sleep and regular sleep patterns are considered essential to a healthy human existence. 5. Checkups: See our doctor for regular visits (not just when our are sick) and keep our shots up to date. 6. Blood Pressure: Control our blood pressure and cholesterol 7. Manage Stress: Reduce stress in our life 8. Healthy Skin: Protect ourselves from too much sun - don’t sunbathe or use tanning booths. 9. Stop Smoking: Smoking has no place in a healthy lifestyle. 10. Substance Abuse: Alcohol and stimulants such as caffeine should only be consumed in moderation and narcotics should be avoided at all costs. If we have a problem with alcohol or drugs there are retreats and clinics to help us. 11. Sexual Health: Practice safe sex 12. Women’s Health: For women - check your breasts and get regular Pap smears 9
  • 10. 3.1 Healthy Living • Blood Pressure Health: For many, blood pressure is not a daily concern. Between waking and sleeping, the strength and speed with which our hearts pump and the resulting impact on our arteries and overall health goes mostly overlooked. However, for close to one billion people around the world with high blood pressure, or hypertension, it is of great importance and something that everyone could stand to pay more attention to. Simply put, blood pressure is the force of our pumping blood pushing against the walls of our arteries. Measuring the blood vessels during a heartbeat and the moment of relaxation in between provides a dual reading known as systolic and diastolic pressure. Statistics reveal that people who have normal blood pressure even into their early 50s still have a 90 percent likelihood of developing high blood pressure in their lifetimes. Affecting nearly 50 million Americans at present, the chance of developing high blood pressure is too large to ignore. High systolic pressure, especially in people over the age of 50, carries a number of significant health risks. Heart disease, stroke, heart failure, heart attack, kidney failure and even death are linked directly to prolonged hypertension. As frightening as that may sound, a confirmation of high blood pressure does not have to be the beginning of the end. Lowering the systolic pressure is necessary and several methods exist to accomplish this and control high blood pressure. In most cases, a number of lifestyle changes are required. Dietary adjustments can be of great benefit in lowering high blood pressure and many health-care providers encourage their patients to increase their daily intake of fruits, vegetables and fiber. Decreasing fatty foods, dairy products, salt and red meats are also counseled. This nutrition program is generally referred to as the DASH plan, meaning Dietary Approaches to Stop Hypertension. 10
  • 11. Other approaches to healthier living go hand in hand with the DASH plan, such as limiting alcohol consumption and not smoking. Exercise is of obvious benefit and aerobic activity in the form of swimming, walking, jogging or cycling for 30 minutes every other day will not only lead to a more appropriate body weight and lower blood pressure, but will allow any medication required to assist in controlling high pressure to be that much more efficient.• Checkups Also known as health exams, physical examinations or routine physical examinations, checkups can find problems before they start or before they get a foothold, and as we all know, prevention is better than cure. Although many consider the need for having health checkups unnecessary or only for those with advanced years, having regular annual checkups is a good idea for people from the age of 30 years. Those into their 50s who don’t go for regular checkups should have a rethink, as this is the age when diseases may start to set in more frequently, plus the body generally shows signs of wear and tear at an increased rate. The depth of checkups we need will depend on a number of criteria, including our age, our current state of health and our family history, as well as whether we smoke, our level of fitness and even what we eat. Health checkups generally include a weight check, blood pressure check, regular pulse check, vision tests, and a lookout for breast cancer, testicular cancer, prostate cancer, and cholesterol levels, for example. As a preventative measure, doctors will generally advise smokers and drinkers to cut back on their intake, exercise regularly, and try to reduce stress levels. In truth, eating properly and exercising are the two biggest factors for ensuring we give our body the chance of a healthy existence. 11
  • 12. General practitioners (GPs) generally do health checkups and are the best bet to help us feel more at ease, if we are apprehensive about having a checkup. Family doctors are ideal in this respect. For more thorough checkups, a trip to the hospital will generally be necessary. Regarding self checkups, getting into the habit of analyzing our body whenever in the shower is a good idea for picking up the odd lump or bump. Do this every other day, or perhaps weekly - women checking for unusual lumps or bumps on their breasts and men checking for abnormalities in the scrotal area. A full checkup with our doctor, or at the hospital, should be undertaken at least every 12 months.• Health Fitness Exercise is not only important for our heart, but it is also essential for maintaining a healthy weight and general well being. Not only can regular exercise half our chances of developing coronary heart disease and reduce our chances of having a stroke, but it also helps to lower blood pressure, reduce our chances of developing diabetes and can assist us to loose or maintain weight. In addition to the numerous health benefits of exercising, regular activity can also help to relieve stress, make us feel more energetic, help us to become more independent and lower our risk of osteoporosis. The great thing about exercise is that we will benefit from it as soon as we become more active. If we do not already exercise regularly, we need to start slowly and consider any health conditions that we have. Starting with a gentle form of exercise such as walking or swimming is a good way to build up our strength before taking up a sport or joining an exercise class. Even dancing, cycling to work, gardening or climbing the stairs is considered exercise. It is important to increase our activity gradually. Warm up before exercise and cool down after. If we experience any adverse symptoms when exercising, such as chest pain, it is important to consult our doctor, who will be able to advise on a safe level of activity for us. 12
  • 13. Aerobic activities such as walking, cycling and swimming are the most suitable forms of exercise to start with. Avoid intense activities such as press-ups and weightlifting until one have achieved a reasonable level of fitness. Ideally one should exercise moderately for 30 minutes five days a week. It is possible to split one’s exercise into shorter sessions if you easily tire. An unhealthy lifestyle and physical inactivity can contribute to you gaining weight and can cause an increase in blood pressure. Regular exercise can reduce high blood pressure or prevent us from developing high blood pressure. Build more activity into our daily life and begin to see the benefits of regular exercise immediately.• Healthy Diet Opinions on healthy eating have changed greatly over the last half-century and in many Western countries what was previously considered a balanced diet is no longer considered such. Almost on a daily basis, science discovers new foods and edible substances that are deemed beneficial to health and longevity as well as the ill effects of foods previously deemed nutritionally sound. General consensus, however, dictates that a healthy diet should be low in saturated fats and high in fiber and that the number of calories we consume should be appropriate to our age, weight and level of daily activity. Beyond this, dietary specifics depend on the individual in question and any physical conditions or internal or external factors that might result in increased or decreased requirements for certain nutrients or compounds. “You are what you eat” is an old adage, but not one without credible foundation, with plenty of evidence to suggest that individuals who eat a balanced diet are far less likely to succumb to illness and disease than those who don’t. The amount of proteins, fats and carbohydrates we consume is appropriate to our individual physical requirements. 13
  • 14. The above-mentioned compounds are commonly referred to as the three major food groups and nutritionists advise that for the purpose of good health, proteins should be a mix of animal and vegetable sources, fats consumed should be predominantly mono and polyunsaturated, and carbohydrates should be largely of the non-refined variety. Balance in diet can also refer to our intake of vitamins and minerals, and while certain circumstances such as pregnancy, illness or athletic activity can increase our need for specific nutrients, there are general guidelines for requirements. These guidelines are commonly known as Recommended Daily Allowances (RDA) and are devised using the needs of the average child, adult male and adult female as determining criteria. There are numerous other issues pertaining to a diet conducive to healthy living, with many individuals seeking the assistance of dietary supplements to address specific health requirements. Although some evidence exists to support the efficacy of certain supplements, nutritionists advise that such products should only be used in addition to and not as a substitute for a well-balanced diet• Healthy Skin While most of us enjoy a holiday at the beach and returning to the office with a deep, bronze tan as evidence of our dedicated hours in the tropical sun, the idea of a healthy tan has led us down a dangerous path. Although the sun provides us with necessary vitamin D, only an occasional 10 minutes of exposure is required. Prolonged exposure damages our skin, leading to wrinkles, discoloration and other blemishes while overexposure (sunburn) has been linked to sun poisoning, sun stroke, skin cancer and even death. Statistics show that in the United States, someone dies everyday due to melanoma. The detrimental effects of the sun are irreversible, so during next vacation to a sunny ski slope or a sandy beach keep the dangers of the sun in mind and take care of skin. 14
  • 15. Fair-skinned people should avoid direct sunlight from 10:00 to 15:00 as a rule. Sunscreen should be applied at least 20 minutes prior to exposure and reapplied frequently. Sun block, on the other hand, provides instant protection and allows for immediate exposure. Either should be reapplied in accordance with the degree of perspiration or time in the water, regardless of whether or not the product is labeled as waterproof. UVA rays are the primary cause of premature aging, so wear a hat with a brim, loose-fitting clothing and sunglasses during those afternoon walks along the beach or while relaxing on the ski-lodge patio is recommended. The winter sun is just as dangerous as the summer sun and often more so due to the amplified reflection off the snow and ice. Remember too that overcast skies do not mean we are protected. Diffused rays can cause severe sunburn, even underwater. If returning from our holiday with milky white skin is a concern, consider that the medical expenses for the treatment of sun-induced disorders such as cold sores, eczema, wrinkles, loss of elasticity, sunburn and damage to the immune and vascular systems are far greater than the cost of a good hat, a pair of sunglass, a long-sleeved shirt and some sun block.• Healthy Sleep “Sleep, those little slices of death, how I loathe them”, wrote celebrated author of mystery and macabre, Edgar Allan Poe. If only Poe had realised the importance of sleep, he might have lived past his 40 short years. Indeed, evidence indicates that good sleeping habits can increase life expectancy. The science of sleep has been well studied and physicians have determined that a prerequisite of a healthy lifestyle is sufficient sleep to meet physical and mental needs. Though requirements vary according to factors such as age and level of activity, it’s generally accepted that eight hours (with a variance of an hour more or less) is a healthy period of time to spend at rest. 15
  • 16. Though eight hours is considered an optimum period, there are many factors that can increase an individual’s need for sleep. Heavy exercise, illness, stress, depression and prolonged mental activity are among the most common circumstances. In such cases, nine or 10 hours may be considered more appropriate. Sleep is important for a variety of reasons and scientists have successfully broken its functions down into the following categories: restoration, preservation, memory processing, ontogenesis and anabolism. Though each of these areas can be explored in depth, in short, they refer to the processes required by all humans for unhindered mental and physical development and for the repair of any injuries sustained to either mind or body through disease or daily activity. Healthy rest depends on good sleeping habits and by this we mean going to bed and getting up at more or less the same times every day. In doing this, our internal body clocks become more finely tuned and we are not only able to fall asleep quicker, but we also benefit from more restful and productive periods of sleep. Avoiding stimulants such as caffeine, nicotine and theobromine (from chocolate) for at least four hours before bedtime is sensible if seeking restful sleep. Furthermore, drinking alcohol prior to sleep is inadvisable, as its effects tend to disrupt deep sleep patterns. Regular exercise can be useful in establishing healthy sleep routines; however, its best avoided two to three hours before bedtime as it encourages increased activity of the heart and nervous system, thereby becoming a hindrance to restful sleep.• Manage Stress Everyone feels stressed at one time or another, through work constraints, demanding relationships, health, and so on, and how we manage that stress is important for our overall wellbeing. 16
  • 17. Stress can affect us in lots of ways, including: emotionally, throughanxiety or tension; behaviorally, through excessive smoking and drinking, beingoverweight, nervousness; and how we think, causing apathy, forgetfulness, andindecisiveness. If stress is not nipped in the bud fast, it can lead to all sorts of mental andeven physical illnesses. Immense pressure is placed on the body through how wethink, leading to an increase in heartbeat, breathing rate and blood pressure, andthe longer this goes on, the greater are the demands we place on our bodies. Common side effects from continued stress include cardiovascular disease(affecting heart and blood vessels), high blood pressure, and an acute proneness toinfection. Chronic fatigue is also common and can last for years if complete rest isnot initiated. As we can see, the way we think can have profound effects on ourwhole system. Luckily there are methods for managing stress and offices set up to help. Itis important to visit our doctor or community health center if we often feelstressed, anxious or depressed, and if we think we cannot deal with our reactionsto stress. Psychologists and counselors are specialists trained to deal with stress inindividuals. There are also basic things we can for our self to help cope with andmanage stress. One of the most important aspects for starters is to make sure weare well nourished and drink plenty of water, as lack of one or both can bring onor exacerbate stress in itself. Maintaining a certain level of fitness is alsofundamental in dealing with stress for similar reasons to being undernourished. In addition, we should also try to understand situations that make us feelstressed and try to avoid them; be it people, events or places. Also understandwhat situations are within our control, prepare ourselves for stressful events bythinking about the future and do things that make us happy. 17
  • 18. • Stop Smoking There is no question that smoking is bad for us, as well as for those around us. Smoking is addictive primarily through the nicotine content (an alkaloid poison) in the tobacco, but also through the appeal of cigarette in-hand for many users. And it’s not all nicotine either; there are numerous other chemicals being inhaled which have profound affects on the body. In short, dozens of cancer- causing chemicals come with tobacco smoke, harming almost all organs in the body that ultimately leads to disease and lack of health in general. Common side affects from smoking include: coughing and wheezing; irritation of the windpipe and voice box; breathlessness; lung irritation and damage. Common diseases caused by long-term smoking include: lung cancer; lung diseases like chronic bronchitis; heart attack and stroke; gangrene through bad blood circulation. Specific negative attributes from smoking in the male body may include impotency and sperm complications, while females may experience reduced fertility, early menopause and increased risk of cancer of the cervix. The good news is that the earlier we quit the better chance we have of reducing our risk of major health complications, such as heart disease, stroke, and cancer. Those who manage to quit by the age of 30 gain a considerable number of years of life expectancy by avoiding many smoking-related diseases. Even those who quit at advanced years can improve their life expectancy. The affects on our health will not be immediate, but after a few months of quitting our heart and lungs will function better. Quitting smoking can be extremely difficult for many smokers who are addicted to nicotine and many people may need extra support when trying to go ‘cold turkey’. Telephone support and quitting smoking courses can help smokers kick the habit, while nicotine replacement therapy is available from pharmacies. 18
  • 19. These include nicotine skin patches and nicotine impregnated lozenges, chewing gum, tablets and inhalers. Tips for quitting smoking: set a stop date and go cold turkey; discard all cigarettes, lighters and ashtrays; ask our smoking partner to also give it up, or at least be away from us when they want to smoke; ask for support from friends and family; take up regular exercise; eat more fruit, vegetables and less fatty foods if we gain weight; and treat ourselves with the money we save on cigarettes.• Substance Abuse There are different definitions of the term substance abuse, but for the layman it is best defined as the use of substances with psychoactive or stimulating properties in manners likely to cause harm to the physical or the mental health of the individual concerned. Substance abuse can lead to serious long-term problems and even death, depending on the circumstances and factors involved. The most obvious example of substance abuse is the abuse of alcohol, a phenomenon common to all societies where alcohol is legally available for consumption. Abuse to the point of addiction is termed ‘alcoholism’ and the most common long-term effect is cirrhosis of the liver, a condition frequently resulting in death. Alcoholism invariably impacts significantly on the families of sufferers. Since the effects to the health of long-term users are well-documented, tobacco smoking can also be considered substance abuse. Smokers experience withdrawal if deprived of nicotine in the short-term and risk complications such as emphysema, lung cancer, respiratory complaints and arterial disease if the habit is pursued over extended periods. The use of illegal drugs such as marijuana, amphetamines, cocaine and heroine may all be considered substance abuse since none are without side effects or the potential for damaging health. Though the dangers involved are specific to each drug and some carry considerably more serious risks than others, the common factor between all is that of dependency. Users can develop physical or mental addictions to these illegal substances. 19
  • 20. Common household substances such as solvents and adhesives, gas and aerosols, paint and lighter fluid can also be addictive. Inhaling these substances brings the risk of damage to the heart, kidneys, brain, liver and other organs, as well as the possibility of Sudden Sniffing Death Syndrome. Many countries offer help for substance abusers; this can come in the form of government-funded projects or private assistance such as is available at rehabilitation centers and retreats at popular medical tourism destinations. Many hospitals have programs dedicated to assisting abusers, not only in their withdrawal from substances but also in the treatment of maladies brought on by them.• Weight Loss If we’re overweight, there are many reasons to lose some of the excess. Healthy weight loss can result in better general health, looking better, feeling better and increased levels of energy. Many people can lose weight but often struggle to keep the weight off once they’ve lost it. When we decide that we want to lose weight, it’s important to start the process with clear intentions and long- term goals. It’s good to start the weight loss process by having a clear idea of how much weight we need or want to lose. To help guide us with this we can ask our health-care provider to conduct a Body Mass Index (BMI) assessment. The assessment will give us a reliable measure of our total body fat by comparing our height and our weight. We can also make this assessment ourselves by using an online BMI calculator. The results of the BMI will place us in one of five categories, from underweight to extreme obesity. Once we’ve established our current weight category, we have to set ourself achievable and realistic goals. It’s better to spread your weight loss goals over a significant period of time rather than going for a quick weight loss program where we will be more prone to regaining weight after we have achieved our initial goal. Start by setting ourselves the goal of losing just a few pounds, then once we’ve achieved that goal, apply a second goal of keeping it off for one or two weeks. 20
  • 21. Diet is one of the most important aspects of losing weight and keeping itoff. Try not to be taken in by fast track diets; while these types of diet may workin the short term, keeping the weight off can be difficult once we get bored of theimposed restrictions of the diet. Instead, start from working with our current dietand eating patterns. For one or two weeks, keep a record of what we eat and drink each day. Behonest and note quantity and portion sizes. Once we have a clear record of whatwe are eating and what our eating patterns are, then make realistic goals based onour records. If we see that we are eating a chocolate bar once every second day,make a goal to reduce this to a frequency that is achievable. Finally, keep active! Exercise and general activity is vital in the process oflosing weight healthily and keeping it off. Again, set achievable goals that we canincrease as time goes on. We may want to start with something simple likewalking to pick the kids up from school rather than driving.Women HealthFor women to stay healthy there are a number of special issues they shouldconsider to avoid female-related illness and disease. With the increase in breastand cervical cancer cases, it’s particularly important for women to ensure that theyconduct regular self-examination of breasts and have regular cervical Pap testsBreast cancer is one of the most common forms of cancer in women. When breastcancer is discovered early and treated quickly, the possibility of curing the diseaseis much higher. It’s therefore essential for women’s health that all women conductmonthly self-examination in order to detect any early signs of the disease. If youshould discover anything unusual, pay a visit to your women’s health-careprovider who will advise you in undergoing further tests if necessary. 21
  • 22. Cervical cancer is also a common form of cancer in women and like breast cancer,early detection of the disease can increase the possibility of cure. To check forcervical cancer, cells that may result in cervical cancer or other cervical relatedinfections, women should have their health-care provider conduct regular Paptests.How often these tests should be conducted depends of your age and whether yousuffer from any other medical conditions. Your doctor will advise you how oftenyou need to be tested and of any other necessary precautions women should taketo stay healthy. 22
  • 23. 4. Health Spas and Massage - Health Tourism Massage has been used for centuries to relieve stress and treat a variety of healthconditions. Ancient civilizations from Rome and Japan to India incorporated massagetechniques into their medical treatment regimens. Today, most people are familiar withmassage as a luxury spa treatment, and many new techniques have been developed toappeal to an ever widening taste for exotic and effective wellness experiences. The term ‘massage’ is generally used to describe treatments that use pressure tomanipulate the body’s soft tissues. Target areas can include skin, muscles, ligaments,tendons, joints, and other connective tissue. In addition, some massage therapies targetlymph vessels and various organs of the body. The goal is to promote healing, supportwellness, relieve stress, and clear the mind of clutter. The massage practitioner may use hands, feet, fingers, elbows, forearms, ormassage aids during a treatment. Scented or unscented oil is often used while heatedstones are now used in one of today’s popular massages. Depending on the type ofmassage, clients are clothed or unclothed. If unclothed, towels or sheets are draped forprivacy and only the area being worked on is uncovered. Clients may be seated on amassage chair or lie on a massage table or a mat on the floor. 23
  • 24. The types of massage most familiar in western cultures include Swedish, deeptissue and sports massage. Asian massage techniques include Ayurvedic, Thai, Shiatsuand reflexology. Beyond these traditional methods, there are many types of massage thatcombine techniques, incorporate stretches, or target specific trigger points. Medical massage is used increasingly for conditions such as breast cancer, sinusrelief, and temporarily reducing blood pressure. Other types of medical massage are usedto relieve pain. Massage therapists and practitioners are usually regulated by a governing agencyof the country where they practice. Because there is no single entity regulating massage, itis best to ask your practitioner about their qualifications and training, or ask to see alicense or certificate verifying their compliance with local regulations. Countries with Health Spas: Czech Republic, Estonia, France, Germany, Hungary,Italy, Japan, Mexico, New Zealand,Philippines, Poland, Romania, Singapore,Slovakia, Slovenia, Thailand, Vietnam, USA.India is also emerging as a new health tourismdestination. Kerala is world famous for itsAyurveda and Massage therapies. We willlater discuss scope of Health Tourism inHimachal Pradesh. 24
  • 25. 5. India Health Spas While not as popular a spa destination as Asian counterpart Thailand, India is anup-and-coming spa destination that attracts thousands of spa-goers each year with itsunique treatments not found elsewhere. Specializing in yoga, ayurvedic therapies and massage, Indian spas offer exoticwellness treatments suited to treating a range of ailments as well as generally rejuvenatingthe body as a whole. The growing spa industry in India is centered in Kerala, but there arequality spa resorts in most major tourist destinations. Better known for their specialist treatments than for their luxuriousness, Indianspas are among the most affordable spas in the world and offer a range of services. Somespas are part of resort complexes that offer accommodation and introductions into age-oldpractices such as yoga, meditation and ayurveda. Popular health spa treatments in India include: ayurvedic massage, rejuvenationtherapy and water therapies as well as standard spa treatments found elsewhere, such asfacials, body wraps and exfoliation. Many patients come for the alleviation of healthconditions through the use of ayurvedic medicines and therapies by qualified physicians. Unlike spas in many other parts of the world, spas in India typically offer insighton how to achieve a healthy lifestyle that maintains balance and harmony throughcenturies-old traditional methods. Ayurveda, yoga and meditation are all useful tools thatIndian spa therapists use to assist patients in making healthy lifestyle changes. 25
  • 26. The modernity of spas in India is variable, but most health spas catering toforeigners are well equipped with contemporary facilities and trained professionals. Manypeople complement their spa treatments in India with sightseeing or a break by the beachat a luxury resort. Not all spas in India are regulated, making it essential you research the spa youwish to visit before seeking treatment. Make sure you choose a therapist that hassignificant experience in their field before undergoing any major spa treatment or therapyin India. 26
  • 27. 6. Types of Massages for Health Tourism • Acupressure massage A traditional Chinese medical practice, acupressure is a technique based on the belief that stimulation of certain points of the body can bring relief of medical symptoms and their root causes. The practice is similar to acupuncture, making use of meridians (channels along which the body’s life energy, or qi, flows) to encourage the body to heal itself without need of drugs or surgery. Acupressurists will diagnose a patient’s problem based on the description of their symptoms and with little in the way of a physical examination aside from checking the patient’s pulse. The patient’s condition is, in Chinese medical terms, related to interference in the natural flow of qi (pronounced chi) in a specific area of the body. An Acupressurist will attempt to address this interference by applying pressure to specific points along the meridians with the hands, elbows or tools. The points chosen may or may not be focused in the area where the patient’s symptoms are located. Acupressure can be used to relieve a wide selection of ailments and is commonly reported to be successful in aiding those wanting to lose weight or quit smoking. Many pharmacies sell acupressure wristbands designed to alleviate the symptoms of pregnancy nausea or travel sickness, suggesting that there is some mainstream acceptance of acupressure theory. There is no scientific evidence to show correlations between acupressure and health benefits. However, there is some acknowledgement within the medical community of its benefits, with local GPs and medical specialists often referring patients for acupressure treatment when conventional approaches have proved ineffective. 27
  • 28. • Aromatherapy massage Popular among followers of alternative and complimentary medical approaches, the principles of aromatherapy are several millennia old. Historians believe that it was probably the Chinese who first developed the belief that ingesting the vapors of oils derived from certain plants and their fruit can be beneficial to both physical and mental health. Although often under scrutiny from the conventional medical community, aromatherapy is regularly practiced. The most common means of ingesting essential oils is by inhalation. Oils are diluted with water and placed in an oil burner, with a candle producing enough heat to cause the oil to evaporate. As the vapors permeate the air, their effects may be felt by anyone in close proximity. The alternative to this method is to add a small volume of essential oil to base oil such as sweet almond and then apply to the body through massage. This technique allows external ailments to be treated directly, as opposed to inhalation which is intended to have a more general and systemic effect. Oils can be used to treat a variety of complaints with inhalation said to aid headaches, symptoms of common colds, stress, anxiety, insomnia and digestive complaints. Topical application is allegedly efficacious in treating arthritis and rheumatism, skin rashes and infections, warts, insect bites and minor wounds. Some elements of aromatherapy have worked their way into mainstream culture and consumerism. Nowadays it’s not uncommon to see essential oils such as tea tree added to popular skin and hair care products. Lavender is widely acknowledged for its calming effects and is commonly added to bath oils, pillows and inhalers (aroma sticks). 28
  • 29. • Cranio sacral massage Cranio sacral therapy, known as CST, is a type of gentle bodywork or therapy that targets the membranes and cerebrospinal fluids that surround and cushion the brain and spinal cord. CST therapists believe that when this fluid is blocked, an imbalance occurs and illness and injury can result. CST concentrates on the cranio-sacral system, which is made up of the soft tissue and bones of the cranium (head), the pelvis, and the spine. Spinal fluid that travels through this system can be restricted by trauma to the body such as a fall or an accident, or through tension brought on by stress or nervousness. A blockage in this system can cause muscle and joint strain, emotional disturbances, and impeded operation of the body’s organs and central nervous system. A variety of healthcare providers practice CST in the course of their treatments. Dentists, massage therapists, chiropractors, osteopaths, occupational therapists, and nurses may all use CST to establish harmony in the central nervous system and assist in healing. During a full CST session with a specialist in this therapy, the movement of the cerebrospinal fluid is assessed. While lying face up on a massage table, the therapist gently manipulates the bones of the skull, spine and pelvis as well as the soft tissues of these areas to release blockages. Depending on the severity of the condition, more than one treatment session may be scheduled over a period of time. CST is commonly used to treat migraine headaches, sinus problems, TMJ syndrome, fibromyalgia, mental stress, and neck and back pain to name just a few conditions. CST takes advantage of the body’s natural healing capabilities and is often used along with traditional massage to help the body regain balance. 29
  • 30. • Endermologie The unsightly dimpling of the skin on thighs and stomachs, called cellulite, is an endless source of frustration for many adults. Even very fit people may have cellulite, and weight loss and liposuction do not always affect the appearance of cellulite. Endermologie, a non-surgical and non-invasive technique that reduces the appearance of cellulite, is one approach to combating cellulite. Endermologie was developed by French plastic surgeons and the technique is now patented in the United States and approved by the Food and Drug Administration (FDA). The technique uses rollers and suction to redistribute the top layer of skin and reduce the dimpling effect of cellulite. It does not remove the fat under the skin, as liposuction does, but rather treats the skin’s appearance. During an endermologie session, a small, motorized device with two adjustable rollers and suction is applied to the problem area. The skin is gently folded and unfolded under the continuous action of the rollers, creating movement in the deep tissues. As the subcutaneous fat layer thins, blood and lymphatic flows increase, which causes the excess fluid to be released. Endermologie is most effective on fit persons between the ages of 30 and 45. People who do not exercise regularly may see only temporary results, and people more than 30 pounds overweight will most likely see no results from the treatment. Typically, 14 to 28 sessions are required, with monthly treatments thereafter. For maximum benefit, drinking eight glasses of water every day is recommended and regular exercise will also extend the benefits of the treatments. In addition to treating the appearance of cellulite, endermologie has some significant health benefits. It improves circulation, stimulates collagen production, causes deep lymphatic drainage and can improve symptoms of fibromyalgia and chronic fatigue. This technique can also be used to soften burn scars and connective tissue. 30
  • 31. • Hot stone massage This highly relaxing form of massage is known for its stress-reducing properties. The hardness of the heated stones means the therapist can apply deep pressure, making this a good form of therapy if you want to address a specific area. Although this form of massage has been around for centuries, it only recently became internationally popular when US massage therapist Mary Nelson introduced its current form in 1993. The water-heated basalt stones used in hot stone massage vary in size and weight with some as small as a walnut while others come in at over one kilogram. The heat level of the stones is closely monitored before they are used. Stones below 118°F can fail to relax the muscles while stones over 129°F can cause discomfort to the client. Heated stones are typically placed under the client with a sheet of fabric in between. Other heated stones are then used for massaging the client along their leg, torso and arm muscles with the help of oil. The process is repeated on both the front and back of the body. Cold stones are occasionally used towards the end of the session. As the stones can target specific areas with ease, with the added benefit of the relaxing effects of heat, hot stone massage is considered to be very mentally relaxing. The benefits may also include improved circulation and calming of the nervous system. It is necessary to choose a therapist who has been properly trained in this type of massage. 31
  • 32. • Lymph drainage massage Manual lymphatic drainage (MLD) is a gentle massage technique that improves circulation of the lymph through the lymphatic system. The human body’s lymphatic system drains fluids, detoxifies and regenerates tissues and helps maintain a healthy immune system. A lymphatic system that functions at its best is critical to the bodys health and wellbeing. In the 1930s, Dr Emil Vodder and his wife Estrid began using MLD to treat chronic sinusitis and other disorders of the immune system. They developed a technique of gentle hand movements to cause lymph movement and introduced their method in Paris in 1936. This technique is now one of the primary tools used to manage lymph-edema, a condition where the lymphatic system is obstructed. When the lymphatic system is obstructed, toxins accumulate and physical ailments can result. Lymphatic drainage massage therapy stimulates and moves excess fluid away from swollen areas so that it can drain away. It combines slow, gentle pressure with soft pumping movements in the direction of the body’s lymph nodes. The massage therapist usually starts with the lymph nodes in the neck and moves down the body, then out to the limbs. This massage technique uses the pads of the fingers and thumbs and the palms of the hands. The increase and decrease of pressure creates a suction and pumping effect that mimics the body’s natural action. Cancer treatments such as radiation and surgery can cause the lymph system to become blocked. With breast cancer, this often occurs in the armpit. Nodes in the groin area or the pelvis can occur if cancer affects these areas. MLD is very helpful in relieving swelling and helping the immune system to recover. In addition to these serious situations, MLD can also improve the appearance and health of skin. 32
  • 33. • Microdermabrasion Microdermabrasion is a recently developed skin care technique used as an alternative to face lifts, plastic surgery, chemical peels and Botox. It is effective in reducing fine lines, sun damage, age spots, wrinkles and acne scars. Even better, it stimulates the production of skin cells and collagen for healthier skin overall. In microdermabrasion, tiny grains are used to gently buff away the top layer of skin, or stratum corneum. The stratum corneum is composed of dead skin cells that protect new skin cells growing beneath it. This layer is also where wrinkle lines and blemishes reside, so removing this layer also removes these imperfections in the skin. When the stratum corneum is removed, the theory is that the body rushes to replace the lost skin cells with new, healthy ones. Microdermabrasion is performed in salons and clinics by trained technicians or dermatologists. At a clinic or salon, the technician or dermatologist uses a tool that sends out a stream of tiny crystals (aluminum oxide, sodium chloride or sodium bicarbonate) and collects the leftover dead skin cells and used crystals in the tool’s vacuum. Some newer tools use a diamond-tipped wand instead of a stream of particles. In the first hour after treatment, the skin may show mild redness and swelling that can last from an hour to several days. For men and women, microdermabrasion is most often used to improve skin on the face, chest, neck, arms and hands. This technique has virtually no side effects and gives the skin a fresh, healthy glow. It is effective on all skin colors and types and can be used for skin that is sensitive to chemical procedures. A milder version of microdermabrasion can also be performed at home with over the counter creams and lotions. 33
  • 34. • Myofascial release Myofascial release therapy is a massage technique that reduces or eliminates pain and tensions in the connecting tissue (fascia) of the human body. Stress, injuries, overuse and poor posture can cause restrictions to fascia. Myofascial release therapy is directed at freeing these constrictions or blockages. Fascia is tightly woven tissue that covers and interweaves every part of the body including nerves, veins, muscles, and internal organs. This fascia is one continuous system that ties the entire body together without interruption. It provides support and structure, but is also flexible so that we can move and bend with ease. Damage or injury to fascia affects more than just the area directly affected, making healing damaged fascia important for the body’s overall health and wellbeing. The developers of myofascial release therapy have backgrounds in physical therapy, rolfing, and other types of neuromuscular therapies. During a session, the therapist gently stretches tissues along muscle fibers. The stretch is held until the tension is released and the tissue softens. Stretches may be held for up to several minutes. A single session may last up to an hour and several sessions may be held over a week or more, depending on the severity of the condition. Myofascial release therapy is also commonly used to treat back pain, shoulder pain, headaches, fibromyalgia, chronic fatigue syndrome, menstrual problems, incontinence, tennis or golfers elbow, shin splints, sprains, rheumatoid arthritis, muscle spasms, whiplash injuries and carpal tunnel syndrome. In addition, myofascial release can be used to treat children suffering from birth trauma, head injuries, cerebral palsy, and scoliosis. 34
  • 35. • Prenatal/postnatal massage For thousands of years and across many cultures, massage has been and continues to be an integral part of easing a woman’s pregnancy, labor, delivery and recovery after birth. In western society, pregnancy massage is becoming one of the fastest growing massage therapies. Expectant mothers experience unique physical and emotional changes due to increased weight, shifting posture, and changing hormone levels. Physical discomfort ranges from muscular tension and headaches to pressure on knees. These changes can create both physical and mental stress. Too much stress can negatively affect the health of both the mother and the baby, resulting in a higher incidence of miscarriage, premature labor and other complications. Massage can help a woman before and after birth by reducing both anxiety and physical pain. Prenatal massage takes traditional massage techniques such as Swedish or a deep tissue massage and tailors them to address the issues and conditions that a pregnant woman faces. For example, more time is spent on easing low back and hip pain, swelling, nausea, constipation and heartburn. During the massage, a pregnant woman is nestled in pillows or specially designed cushions and lies on her side or in a semi-reclining position. During labor, massage strokes on the backs and legs have been shown to speed labor and reduce the instances of complications in labor. After the babys birth, massage therapy can help the body return to its pre-pregnancy state, alleviate pain, promote a renewed sense of body and self, and help maintain flexibility despite the physical stresses of infant care. For post-caesarean mothers, postnatal massage techniques can also reduce scar tissue and aid the healing of the incision and related soft tissue areas. Expectant mothers should check with their doctors before getting a massage. Prenatal massage may not be recommended if the mother has diabetes or high blood pressure. Information about medical condition and personal preferences should be shared with the massage therapist so the massage can be tailored to meet specific needs. 35
  • 36. • Reflexology If the way to a man’s heart is through his stomach, then it should come as no surprise that the road to health and wellness may lie in the soles of the feet. Reflexology, also called ‘zone therapy,’ is based on the belief that the bottom of the foot is covered with points that correspond to the body’s systems and parts. Massaging these points can bring healing and wellness to the body and rebalance its energy flow. Practices relating to reflexology date back to the ancient civilizations of China, India and Egypt. However, the technique was first introduced to the West in the early 1900s by Dr William Fitzgerald, who called the technique ‘zone therapy.’ Eunice Ingham developed Fitzgerald’s theory further and in the 1930s, reflexology was born. Today, reflexology has been shown to be effective for back pain, sports injuries, digestive and stress-related disorders, migraines, infertility, arthritis, sleep disorders and hormonal imbalances. A trained reflexologist first questions a patient about their medical history and current health issues to better direct treatment. Feet are then soaked in water and herbs, and then the therapist locates specific points on the soles of the feet or sometimes palms of the hands. Fingers are used to stroke and apply pressure to these points and to crush small ‘crystals’ that are deposits of lactic acid that build up in the feet. These crystals are then reabsorbed into the body and eliminated by the lymphatic system. Sessions generally last one hour, but a course of sessions may be prescribed depending on the specific needs of the patient. Every person’s experience is unique to them, and the therapist relies on information from the patient about how they feel and what they experience during the treatment. Because reflexology stimulates the body’s own self-healing, patients may feel nauseous, lethargic or tearful as the body begins to heal itself. 36
  • 37. • Salt glow One of the most popular spa treatments today is salt glow. Incorporating scented oils and therapeutic salts, this treatment stimulates the skin and exfoliates it, leaving the recipient of this luxurious treatment with a healthy glow. Salt glows are also known as ‘salt scrubs’ and ‘sea salt scrubs,’ but they are essentially all the same. Because the salt is combined with oil and some type of aromatic such as lavender or lemon, it also hydrates the skin. Treatments can vary slightly at different spas, and most spas combine a salt glow with other treatments such as body wraps, steam showers and massages. The salt glow treatment itself takes between 40 minutes to an hour. During this relaxing and invigorating treatment, clients lie unclothed on a massage table or special wet table with a sheet or towel draped for modesty. The therapist rubs a mixture of sea salt and oil over the skin, covering both front and back sides of the body. Because salt is somewhat abrasive and therapists may use different amounts of pressure, it is important to speak up if the pressure applied is too much, or to request more pressure if desired. Afterward, the salt mixture is rinsed off. If a wet table is used, the therapist may use a hand-held showerhead or moist towels to remove the mixture. Some wet tables incorporate an array of showerheads that spray over the body. Other spas may provide a convenient shower enclosure for rinsing off. Once all traces of salt are removed, other treatments follow, most often a body wraps or massage. If no other treatments follow, the therapist applies body lotion with massaging strokes, leaving the skin feeling soft and radiant. 37
  • 38. • Shiatsu Shiatsu is a Japanese style of acupressure developed over 5,000 years ago. Shiatsu combines the principles of traditional Chinese medicine with those of acupuncture, but it is performed with finger pressure instead of needles. There are a number of acupressure techniques, and Shiatsu is the most well known of these. Shiatsu practitioners believe that our vital life force, ‘chi’, flows in connected channels, or meridians, throughout the body. An organs chi can be accessed at certain points along the meridian. Shiatsu systematically stimulates the body by pressing on specific points along these meridians. Finger pressure stimulates the nerves and tissues, influencing the flow of chi. Poor or blocked chi circulation causes disharmony in the body that may show up as pain, emotional stress, depression, fatigue and disease. Proper chi circulation along the meridians creates harmonious movement and balance throughout the body. Shiatsu stimulates the circulation and the flow of lymphatic fluid and the hormonal and immune systems, releases toxins and tensions from muscles, and acts on the autonomic nervous system, allowing deep relaxation and promoting the body’s natural healing power. During a Shiatsu treatment session, loose clothing is worn and no massage oil is used. Shiatsu uses a combination of pressure and assisted-stretching techniques, some of which are common to other therapies. Shiatsu is not recommended for people with heart disorders, multiple sclerosis or cancer. Shiatsu can promote a sense of well being, but it also has a number of temporary side effects resulting from the blockages being released. Patients may feel tired or emotional, or experience coughing, excess mucus or headaches, or other pains and aches after treatment. In general, any such effects are considered positive signs that the body is making an attempt to correct its own condition in a natural way. 38
  • 39. • Sports massage / deep tissue massage Increasingly, athletes and trainers are embracing massage as an integral part of their athletic regimens. Massage can treat sore muscles, promote healing, maintain health, and perhaps give an edge to competitive athletes by increasing their range of motion and flexibility. Weekend warriors, gardeners, parents of small children, and others who use their bodies in strenuous activities are also discovering the benefits of sports massage. Muscles, tendons and soft tissues can become stiff and sore for a variety of reasons. These include over exercise, damage to tissue, a build up of waste products and muscle spasms caused by reduced blood flow. Trigger points, or stress points, are specific spots on a muscle or tendon that are painful when pressed. Trigger points may be caused by falling or being hit, or they can develop over time from stress and strain. Sports massage often incorporates deep tissue techniques to work a specific joint, muscle or muscle group. Deep tissue massage does just what its name suggests: it reaches the deeper layers of the soft tissue. The practitioner uses fingers, knuckles, elbows, opposing thumbs, the heel of a hand or foot, and the forearm to reach these tissues. Pressure is applied gently at first and then becomes stronger as the deeper tissues are reached. Very little lubricant is used since this type of massage doesn’t travel generally over the skin, but is more focused on specific points. Regular sports massage can reduce the chances of injury by preparing the body for exercise. It can also reduce the amount of recovery time between workouts, improve flexibility in muscles and joints, and make the body more efficient in processing nutrients and oxygen. 39
  • 40. • Swedish massage Swedish massage is one of the most well known and popular massage techniques today. This full body treatment helps the body to cleanse itself of toxins, relieves muscle tension, reduces stress, improves circulation and promotes relaxation. It is often used for patients with stiff joints and is helpful in relieving pain for arthritis sufferers. Swedish massage was developed in the 1800s by Dutchman Georg Mezger and later popularized by Per Henrik Ling, a Swedish fencing master and gymnastics teacher. Different types of long, flowing strokes are used in Swedish massage, usually in the direction of the heart. The patient is undressed and draped for modesty and oil, cream or lotion is used to reduce friction against the skin. Swedish massage often begins with effleurage. These are long, gliding strokes meant to calm and relax the muscles. Petrissage are kneading strokes applied using the palm or finger tips to roll and compress muscle tissue. Tapotement is a rhythmic stroke applied with the heel of the hand or edge of the palm that stimulates muscles and helps relieve cramped muscles. Vibration, compression and friction strokes are also used to release tension and reach deep tendons and ligaments. Friction can also help to reduce the formation of scar tissue. Because the skin is the largest organ of the body, massaging it with these specific strokes can set up a chain reaction that affects all the body’s systems in a positive way. It affects the muscles, nerves, glands and circulation systems to promote wellbeing and good health. 40
  • 41. • Thai massage During a Thai massage, the whole body is treated to kneading, manipulation, stretching, and very active involvement with the masseuse. The masseuse uses elbows, knees, hands and feet to apply the massage, providing both stimulation and relaxation. Thai massage shares with other Asian healing practices the concept of energy lines that run throughout the body. These are called ‘meridians’ in Chinese medicine, ‘nadis’ in Indian medicine, and ‘sen’ in Thai. Traditional Thai massage focuses on 10 points along the sen lines that contain important energy points. In the northern style of Thai massage there are a lot of stretching movements, while the southern style emphasizes acupressure. In Thai massage, the recipient wears loose clothing and lies on a mat on the floor. The massage practitioner leans on the recipients body using hands and usually straight forearms locked at the elbow to apply firm, rhythmic pressure. The practitioner sometimes uses legs and feet as well. Oil is not used in traditional Thai massage. A full Thai massage session typically lasts two hours and includes rhythmic pressing and stretching of the entire body. This may include pulling fingers, toes and ears; cracking knuckles; walking on the recipients back; and manipulating the recipient into yoga stretching poses. There is a standard procedure followed in Thai massage that is adjusted according to the length of time requested. Traditional Thai massage has been used for centuries to treat muscle and joint pain, cramps, numbness, loss of strength and function, allergies and emotional stress and tension. It is used now to help treat a wide variety of ailments that include headaches, insomnia, high blood pressure, sciatica, low back pain, diabetes, menstrual pain and more. 41
  • 42. 7. Medical Tourism as a part of Health Tourism Medical tourism or ‘global healthcare’ as it’s increasingly called, involvestravelling to a foreign country for a medical procedure. This industry has been growingrapidly over recent years as more and more people seek faster or cheaper alternatives tothe healthcare offered in their own countries. Occasionally the medical procedure neededis urgent, but more often it is an elective treatment such as cosmetic surgery or dentalcare. The number of people seeking healthcare in foreign countries now runs in themillions each year. Most patients are Westerners attracted to the concept of qualitysurgical treatment for a fraction of the cost they would pay in their own countries. Afterreceiving the medical treatment, the patients take a relaxing recovery vacation in the samecountry. Often patients can pay for their surgery, flight and a week or two at a resort foras little as a quarter of what they would have paid back at home. Leading the medical tourism industry is India, with Thailand and Malaysia closebehind. India’s medical tourism industry grows around 30 per cent annually, thanks to anaggressive marketing plan that focuses on all-inclusive package tours. Thailand’s main institute is Bangkok’s renowned Bumrungrad Hospital, whichcombines luxurious accommodations with world-class treatment. Bumrungrad Hospitalclaims to treat more patients per year than any other facility in the world. MeanwhileMalaysia promotes its many neighboring tourist destinations to match competitive rates,internationally-trained doctors and excellent facilities. The medical tourism industry has emerged in response to the incredibly huge costsof having most surgical procedures performed in countries like the United States, Britain 42
  • 43. and Japan. Without medical insurance, most Westerners have no chance of being able toafford treatment, and sometimes even with insurance the costs are much higher than thoseoffered by Asia’s medical centers. Medical tourism has become big business for thesecountries by offering realistic costs for patients. Besides the obvious economic benefits of having your knee replacement surgerydone in a place like India or Thailand, one can enjoy a well-deserved vacation afterwards.Depending on the nature of the medical procedure, patients can lounge on the beach orvisit the major tourist attractions of the country. If the treatment is more severe, medicaltourism hospitals such as Bumrungrad have accommodations that seem more like a 5-starhotel than a hospital ward. Popular elective medical services include knee or hip joint replacements, cardiacsurgery, cosmetic surgery and dental surgery. Patients in need of emergency proceduresare also attracted to this concept as the wait period for certain operations can take up to ayear or more in their own countries. Often they can have the procedure done immediatelyin another country. Medical tourism fills a valuable niche that is desperately needed in countries withbureaucratically flawed or unaffordable healthcare. This industry looks set to expand at ablistering pace over the next decade as more and more people begin to trust the qualityand see the advantages of having their surgery performed in developing countries. 43
  • 44. 8. Risks of Medical Tourism Looking at medical tourism from an economic perspective makes it easy to seewhy this option is so appealing. Receiving quality, affordable healthcare frominternationally-trained doctors and surgeons in a relaxing resort atmosphere is a greatoption. But patients considering medical travel should be aware that it does carry a fewserious risks. The most common issue related to medical tourism is the quality of the medicalinstitution itself. It can be difficult to check the qualifications of the doctors,anesthesiologists and other specialized staff at medical facilities which are privately-owned and operated. This is particularly true with cosmetic surgeons, who almost alwayshave their own privately-run clinics. It is absolutely essential that any medical tourist thoroughly researches thehospital, clinic or institution where they are planning to have their procedure done. This isbest accomplished by scouring the internet, especially blog sites that provide firsthandexperiences and advice from others who have already completed the procedure. With a bitof research reputable hospitals and clinics are globally well-known and easy todistinguish from shady unqualified doctors. The protection laws in a country are rarely enforceable in other nations. Patientswho receive poor or damaging medical treatment usually have no legal recourse.Malpractice and negligence by either the individual doctor or the institution are veryrarely covered, leaving medical tourists left to fend for themselves. On other hand, it’s thelack of expensive malpractice insurance prevalent in the West that helps keep costs solow in these countries. The issue of follow-up care is another thing to carefully research and considerbefore choosing an institution for your medical care. Most medical tourism packagesprovide very little, if any, follow-up care after your operation. Once you return to yourhome country, any complications that arise will be more difficult to deal with. Again, thisis a particular concern with cosmetic surgery. 44
  • 45. The recovery vacation period so heavily promoted by medical tourism packagescan also carry certain risks. Depending on the extent of the surgery, travelling soon afteran operation greatly increases the potential for complications. Long air flights increasethe chance of swelling, blood clots and infection. Even sunbathing on the beach willdarken the scars. The best solution here is to allow for plenty of time to recover in the countrywhere the medical procedure is done. Don’t assume you can really get out and about toomuch during this vacation period. Rest is what your body will need, so choose calm,relaxing destination for this vacation recovery period. The bottom line is that medical tourism isn’t a perfect, guaranteed option.Travelers will be out of their element both during and after the procedure, potentiallyadding stress to the situation. Post-care varies widely between facilities, so do a thoroughcheck and carefully weigh the advantages of cost versus safety when making thisimportant decision. Chances are, if you pick a reputable hospital or clinic you will have no problemswhatsoever. But as the medical tourism industry continues to grow at such a fast pace, theinevitable quacks will become more prevalent.9. Benefits of Medical Tourism As the technology, doctor training and standards of healthcare in developingcountries has vastly improved in recent years, more and more people are looking atmedical tourism as an attractive solution to their health problems. The popularity ofmedical tourism can be directly traced to the incredibly high costs of healthcare and longwait periods for some procedures in many countries. Medical tourism is not a new idea. Ancient Greek pilgrims used to travel to asmall town called Epidauria for treatment. This area was considered the sanctuary ofAsklepios, the god of healing, and probably the first medical tourism destination. Spatowns were also considered medical travel destinations, especially in 18th centuryEngland, where patients believed the healing waters of some areas could treat gout, 45
  • 46. bronchitis and other conditions. Today, Asian countries such as India, Thailand andMalaysia are leading the way in the medical tourism industry. Medical tourists come from all over the world, but most are citizens of Westernnations such as the United States, Britain, Europe, the Middle East and Japan. The mostobvious benefit for medical tourists is the dramatic savings in cost. A coronary arterybypass at Thailand’s Bumrungrad Hospital costs around one-tenth of what it does in theUnited States. Even more mundane procedures such as extreme dental work can be afraction of the cost in countries such as Thailand. Another major benefit is the speed at which some surgical procedures can becompleted. The waiting period for a hip replacement in Britain, for example, can be up toa year or more. A patient can fly to India, Thailand, Malaysia or the Philippines and havethe procedure done almost immediately. Since most of the doctors and surgeons inmedical tourism destinations have been well-trained internationally, patients can expectquality healthcare at the reputable institutions. Insurance is another factor in the decision to choose a foreign country for amedical procedure. Some orthopedic operations, especially knee and hip replacements,are often not covered by health insurance. As a result, orthopedic surgery has emerged asone of the main treatments performed overseas due to the low cost and freedom to choosewhere to have the surgery performed. People who cannot afford health insurance simply have no choice but to travelabroad for an expensive medical procedure. With an estimated 45 million Americanscurrently uninsured, this creates a huge market for people needing affordable healthcare. A final benefit is the pleasure of adding some travel and adventure to yourmedical needs. For many medical tourists, a trip to Thailand or India will be a first. A bigcomponent of the medical tourism industry is the relaxing vacation period following themedical procedure. Medical tourism destinations promote this aspect just as much as thequality and cost of their healthcare. In Thailand, patients can lounge on one of thecountry’s many beautiful beaches during their recovery, while India offers some amazingspa resorts where luxury and pampering is the focus. Up-and-coming South Africa evenpromotes wildlife safaris as part of its medical tourism packages. 46
  • 47. 10. Medical Tourism in India Popular For: Alternative Medicine, bone-marrow transplant, cardiac bypass, eye surgery, hip replacement Visa Requirements: A valid passport and visa are required.India is a global leader in medical tourism, and one of the world’s least expensive choicesamong medical tourism destinations. Focusing on heart surgery, India also attractspatients with high quality dental care, Ayurvedic spa treatments and other medical andalternative treatments.Medical facilities at India’s leading private hospitals are excellent and state-of-the-art.Despite the country’s reputation for poverty and poor hygiene, the value for moneyoffered here draws thousands of patients each year. Many visitors complement treatmentswith a stay at an ashram where they can learn how to meditate or practice yoga fromexperts in these ancient traditions.Pros: The medical cost savings of having operations and treatments in India are amongthe best in the world, with fees between a third and 10 percent of the equivalent procedurein the US. Many doctors are trained abroad and hospitals attracting international patientsare on a par with those in the west with all staff being proficient in English. In addition,India has many appealing options for recovery with costs for accommodation typicallylow. The Indian health and medical industry is large and boasts some well developedinfrastructure, particularly in big cities such as Chennai, which support the wealthyclasses.Cons: Although India has a rich legacy of cultural sites that attract tourists, it is notpractical to enjoy some of these sites while recovering. If anyone do venture out of asterile hospital environment expect to be exposed to bacteria that may cause a stomachupset or worse. India gets extremely hot in the summer months, with temperaturesreaching 40°C at times. During the monsoons, water-borne diseases become a problemtoo, so choosing a good time to visit is essential. 47
  • 48. 11. Alternative Medicine Treatments • Acupressure A traditional Chinese medical practice, acupressure is a technique based on the belief that stimulation of certain points of the body can bring relief of medical symptoms and their root causes. The practice is similar to acupuncture, making use of meridians (channels along which the body’s life energy, or qi, flows) to encourage the body to heal itself without need of drugs or surgery. Acupressurists will diagnose a patient’s problem based on the description of their symptoms and with little in the way of a physical examination aside from checking the patient’s pulse. The patient’s condition is, in Chinese medical terms, related to interference in the natural flow of qi (pronounced chi) in a specific area of the body. An acupressurist will attempt to address this interference by applying pressure to specific points along the meridians with the hands, elbows or tools. The points chosen may or may not be focused in the area where the patient’s symptoms are located. Acupressure can be used to relieve a wide selection of ailments and is commonly reported to be successful in aiding those wanting to lose weight or quit smoking. Many pharmacies sell acupressure wristbands designed to alleviate the symptoms of pregnancy nausea or travel sickness, suggesting that there is some mainstream acceptance of acupressure theory. There is no scientific evidence to show correlations between acupressure and health benefits. However, there is some acknowledgement within the medical community of its benefits, with local GPs and medical specialists often referring patients for acupressure treatment when conventional approaches have proved ineffective. 48
  • 49. • Acupuncture Acupuncture is a Chinese practice based on the principles of Chinese medicine. The basis of the practice is the premise that the insertion of needles into specific points in the body can bring relief and even the cure the patient of physical ailments or disease. While there is no scientific evidence to back up the benefits of acupuncture, many doctors acknowledge that the practice may be capable of aiding patients who have not experienced any success with the use of conventional drugs or medical techniques. Acupuncturists believe that a person’s medical condition and their consequent symptoms are the result of a disturbance in the flow of qi (pronounced chi and meaning ‘life energy’) in some area of the body. In order to address the disturbance, practitioners insert needles into key point along meridians, which are the channels that Chinese medicine believes are responsible for moving qi around the body. A patient may have pain or symptoms in a specific area of the body. However, the acupuncturist may diagnose the root cause of the problem as being located elsewhere and consequently needles are often inserted into areas other than those where pain or visible maladies are present. The technique involves little in the way of pain or discomfort although it can be time consuming, sometimes requiring patients to endure lengthy periods with needles in their body. Acupuncture can be used as a single approach to a medical condition but is often combined with other elements of Chinese medicine for maximum effect. In western countries, the practice has gained popularity among patients wishing to lose weight or stop smoking. Irrespective of the treatment’s efficacy, it’s widely accepted that acupuncture is safe and presents few side effects for those undergoing treatment. 49
  • 50. • Aromatherapy Popular among followers of alternative and complimentary medical approaches, the principles of aromatherapy are several millennia old. Historians believe that it was probably the Chinese who first developed the belief that ingesting the vapors of oils derived from certain plants and their fruit can be beneficial to both physical and mental health. Although often under scrutiny from the conventional medical community, aromatherapy is regularly practiced. The most common means of ingesting essential oils is by inhalation. Oils are diluted with water and placed in an oil burner, with a candle producing enough heat to cause the oil to evaporate. As the vapors permeate the air, their effects may be felt by anyone in close proximity. The alternative to this method is to add a small volume of essential oil to base oil such as sweet almond and then apply to the body through massage. This technique allows external ailments to be treated directly, as opposed to inhalation which is intended to have a more general and systemic effect. Oils can be used to treat a variety of complaints with inhalation said to aid headaches, symptoms of common colds, stress, anxiety, insomnia and digestive complaints. Topical application is allegedly efficacious in treating arthritis and rheumatism, skin rashes and infections, warts, insect bites and minor wounds. Some elements of aromatherapy have worked their way into mainstream culture and consumerism. Nowadays it’s not uncommon to see essential oils such as tea tree added to popular skin and hair care products. Lavender is widely acknowledged for its calming effects and is commonly added to bath oils, pillows and inhalers (aroma sticks). 50
  • 51. • Ayurveda Also referred to as Ayurvedic medicine, Ayurveda (meaning ‘knowledge of life’) is an alternative medical approach that originated in India. It’s uncertain what period of history the philosophy was conceived, but historians speculate that it’s probably several thousand years old in its simplest form. Ayurveda is a holistic medical approach that considers both body and mind and their relationship to each other when diagnosing and treating a patient. The philosophy holds that we are all comprised of three essential abstract elements or properties, which Ayurveda refers to as doshas. The three doshas are: vata, pitta and kapha, and the degree to which each presides in us may determine our physical and mental characteristics. Ayurveda views disease and physical ailments as imbalances in the three doshas, or the tridosha system as it is otherwise known. Treatment is therefore a means of rebalancing the system and reestablishing harmony in the body. The philosophy holds that this can be achieved through various techniques which include the consumption of Ayurvedic herbs, the administration of special forms of massage, the adaptation of a specific diet, the practice of yoga and regular exposure to certain elements of nature. Having long been popular in Asia, Ayurveda is becoming increasingly popular in the west. Ayurvedic practitioners can assist with specialized treatments, but patients need to be aware of the specifics of their own tridosha system and the elements of their lifestyle that can aggravate it, in order to ensure that further imbalances are not created. The philosophies of Ayurvedic medicine have no scientific basis however many Ayurvedic treatments are unquestionably profoundly soothing and relaxing. The methods of purifying the body known as panchakarma are widely acknowledged as having obvious therapeutic properties including improved circulation; relief from pain, stress and insomnia; increased flexibility and improved athletic performance. 51
  • 52. • Balneotherapy Balneotherapy is an approach to the treatment of disease or physical ailment involving bathing and stimulation of the body by water. The philosophy takes into account the chemical properties of specific sources of water as well as the effects of hot, cold and moving water. The name of the treatment is derived from the Latin word ‘balneum’ meaning ‘bath.’ Balneotherapy can be administered at a variety of locations. However, it’s often pushed commercially by spas which are strategically constructed at natural sources of water that are rich enough in therapeutic elements such as silica, sulfur, selenium, radium, arsenic, lithium, potassium, manganese, bromine and iodine to be beneficial to those who bathe in them. Due to a surge in popularity of spas, balneotherapy has come to mean almost any treatment that involves water including the consumption of water and the inhalation of vapors from waters rich in constituents deemed beneficial to health. The application of mud and sand to the skin is also often classified as balneotherapy. Ingredients used to good effect in balneotherapy are not necessarily found naturally in the water, with herbs such as chamomile, thyme, oak bark and walnut leaves commonly added to warm waters to address specific medical conditions. Balneotherapy is considered an alternative medical practice with little specific scientific evidence to substantiate its benefits. However, there are few conventional doctors that deny the physical and mental health benefits of bathing. As far back as Roman times bathing was recognized for its healing properties and this reputation has ensured that the practice has survived until modern times. Today the affluent enjoy balneotherapy as a spa treatment while those with circulatory, muscular and skeletal complaints among other ailments benefit from the symptomatic relief it provides. 52
  • 53. • Chiropractic Chiropractic is an alternative medical approach that was founded in the USA in 1895 by DD Palmer. It focuses primarily on the body’s nervous, muscular and skeletal systems, seeking to address mechanical dysfunctions through various manual therapeutic techniques. While based on philosophies beyond the boundaries of conventional medicine, chiropractic is practiced in more than 100 countries around the world. Chiropractic treatment typically involves the practitioner manipulating muscles, joints and soft tissues of the patient. Some emphasis is placed on the spine and the belief that disorders associated with it can have a dramatic effect on the nervous system and bring about a variety of complaints in different parts of the body. More modern theories have concentrated on the relationship between structure and function and its subsequent effect on the body’s neurological mechanisms. As one of the better-established disciplines of alternative medicine, chiropractic is also one of the better regulated, with recognized certificates and qualifications available in a number of countries. In the US, chiropractic is the largest alternative medical profession with some 70,000 practitioners in operation. Numbers are also significant in the UK and Australia with approximately 2,381 and 2,500 chiropractors operating in these countries respectively. The most common therapy in chiropractic is spinal manipulation; however, there are a variety of other treatments frequently used including: ice pack/cryotherapy, trigger point therapy, corrective or therapeutic exercise and extremity adjusting. Practitioners in the chiropractic industry remain divided over certain chiropractic philosophies. Traditionalist chiropractors adhere rigidly to the principles established by the founder of the original movement while other practitioners offer treatment based on a combination of chiropractic, conventional medical, osteopathic and naturopathic principles. 53
  • 54. • Herbal Medicine Also commonly referred to as herbalism and sometimes as botanical medicine, herbal medicine is an approach to the treatment of diseases and medical complaints involving the use of plants and their extracts. While herbal medicine treats conditions with the use of plants, many conventional drugs also use medicines derived from plant sources. However, herbal medicine is considered an alternative medical philosophy, as the efficacy of many of the ingredients used has not been scientifically proven. Furthermore, many plant extracts recommended by herbalists have not been approved for use as medical aids and can only be sold under the classification of ‘dietary supplement.’ In the US such products are prohibited by the Food and Drug Administration (FDA) from making therapeutic or health claims on their labels. Herbalism is not a new phenomenon with many now popular supplements such as Ginseng, Gingko and Valerian having been used for medicinal purposes for thousands of years. People in China, India and parts of South America have long made use of certain plants, their fruit and their roots for medicinal purposes while developed countries have typically relied on conventional laboratory- derived medicines. In herbal medicine everyday ingredients, which in the west are commonly only been used for their flavors and cooking properties, are exploited for their therapeutic benefits. Cinnamon is taken to lower blood sugar levels, garlic to boost immune systems and lower cholesterol levels, turmeric as an anti-cancer and anti-bacterial agent and ginger as a treatment for nausea, gastric irritancy and joint pain from arthritis. Two of the most respected alternative medical philosophies from the east, Chinese and Ayurvedic, make use of plants for their alleged therapeutic properties. Chinese medicine sees herbs as capable of addressing imbalances in a patient’s yin (heat) and yang (cold). Herbs are selected on the basis of their 54
  • 55. warming or cooling properties. In Ayurvedic medicine herbs are selected on the basis of their ability to increase or reduce vata, pitta or kapha, the three humors said to be present in individuals.• Holistic Medicine Holistic medicine is a blanket term for any approach to the treating of illness and disease that takes into account the significance of the both the body and mind, looking at the patient as a whole as opposed to just their condition and symptoms. Holistic medicine is viewed as an alternative medical philosophy. However, an increasing numbers of the conventional medical community are now recognizing the validity of holistic approaches to treatment. Holistic medicine includes a large variety of well-established forms of alternative medicine such as homeopathy, naturopathy, Chinese medicine and Ayurvedic medicine. The common feature of these and many other alternative medical philosophies is that they aim to treat the cause of the symptoms as opposed to just the symptoms themselves. The role of the mind in contributing to medical conditions and aiding an individual’s recovery from them is given importance in holistic medicine. Hypnotherapy, for example, concentrates on using the mind to heal the body. Holistic medicine proposes that the mind, a powerful tool when manipulated correctly, can help affect significant physical change. Holistic approaches to medical care are often criticized for the lack of scientific evidence supporting their claims. This, however, does not deter millions around the world from putting their faith in the power of alternative treatments to cure ailments or alleviate their symptoms. 55
  • 56. • Homeopathy Homeopathy is an alternative approach to medical care based on the philosophy that any substance capable of producing symptoms that are associated with a specific illness or medical complaint in a healthy person is also capable of treating a sufferer of that same condition. In other words, a substance that would irritate a normal, healthy digestive system might be used to good effect in treating a dysfunctional digestive system. Like many alternative medical approaches, homeopathy is largely dismissed by the conventional medical community on account of the lack of scientific evidence supporting the benefits of this approach. This, however, does not deter large numbers of advocates of the philosophy from seeking relief from conditions such as depression and anxiety, irritable bowel syndrome, arthritis, migraine, eczema and common colds. Typically, homeopathic medicines are administered in liquid form with the active ingredient having been diluted many times to remove its toxic property while still retaining its therapeutic property. The ingredient is diluted with alcohol, sugar solution or plain water. Remedies can be made up of substances derived from synthetic, plant, animal or mineral sources. Homeopathy can be considered a holistic medical approach since practitioners take into account all aspects of the patient’s physical and mental state. Only when a homeopathist has considered all aspects of the patient, including the patient’s body type, personal likes and dislikes and innate predispositions, is a remedy be prescribed. While the efficacy of homeopathic remedies has yet to be proven by modern scientific methods, it’s generally accepted that most homeopathic prescriptions are safe for human consumption. The levels of ingredients, that would otherwise in their purest forms be considered toxic, are so minute as to be undetectable and hence pose no danger to the patient. 56
  • 57. • Hydrotherapy Hydrotherapy is an increasingly popular means of soothing pain, treating various medical conditions and promoting well-being with the use of water. Water in any forms (hot, cold, steam, or ice) can be used in hydrotherapy to promote healing. The ancient Egyptian, Greek and Roman civilizations were known to use water therapy as a means of improving health. Works on the medical uses of water began to be published in the 18th century, but little scientific evidence to support the alleged benefits became available until recent decades. Today hydrotherapy is used by millions to ease symptoms of musculoskeletal disorders. The two active agents in hydrotherapy are heat and cold, with the former relieving pain and improving circulation and the later reducing swelling. The therapy has six main forms: packings, hot air baths, general baths, local baths, compresses, and fomentations and poultices. In hydrotherapy, a pack, or a wet sheet, is commonly used to stimulate or soothe a patient when enveloped around the body. Like packing, hot air baths, also known as saunas, cause the patient to sweat. A hot air bath is typically made up of one or more chambers of varying temperatures in which the patient sits for up to two hours. General baths can be hot or cold, as can sitz, spinal, foot and head baths, which are collectively known as local baths. When applied correctly local baths can reduce inflammation with alternating between hot and cold bath thought to be beneficial for those with arthritic joints or poor circulation. Compresses, or bandages, can be used to cool or heat, the former used for fevers and the latter for relief of congestion. Fomentations and poultices can be hot or cold and may use electricity among other mediums. Hydrotherapy can be practiced at home or at a clinic. Many spas now offer hydrotherapy treatments such as inhalation therapy, when a sauna is scented with 57
  • 58. essential oils or herbs. Spas are increasingly facilitated with hydrotherapy baths, or Jacuzzis, and Vichy showers that use water jets to massage, relax and stimulate.• Meditation Retreats Meditation is a practice in which an individual seeks to achieve an advanced mental state through a process involving the removal of all natural thought processes other than those required to focus on a single object or action. The practice is closely associated with Buddhism and is believed to have been around for more than 5,000 years. Meditation is considered to be beneficial to both mental and physical health in a number of ways. Many proponents of the practice claim to have conquered illnesses or debilitating medical conditions through meditation. The relief of stress, anxiety and depression are deemed the most obvious mental benefits of regular meditation, while physical conditions such as irritable bowel syndrome, eczema, high blood pressure and asthma can be improved through meditation. Meditation can be difficult for complete novices and guidance through a meditation retreat is often a beginner’s best introduction to the practice. Retreat centers are invariably affiliated with one or more specific religions or philosophies such as Buddhism or Raj Yoga, and students can choose between them depending on their own personal beliefs or leanings. The most popular form of Buddhist meditation known to westerners is Vipassana (the lesser known alternative is Samatha) and is a practice that is offered in many centers in North America and Europe. Typically, students remove themselves from regular life for a period of 10 days or more, during which time the greater part of their day is dedicated to meditative practice. For an authentic Vipassana experience many students travel to Asian countries such as Thailand, where they are able to immerse themselves in meditation without any of the distractions or temptations that western life might 58
  • 59. present. Students are generally assigned a mentor who is responsible for guiding him or her through the retreat and providing instruction into the complexities of meditation processes. Once students have completed their retreats or instruction they can take away what they have learned and attempt to integrate regular meditation sessions into their daily lives in the hope of achieving and sustaining good physical and mental health.• Orthomolecular Medicine Orthomolecular medicine is an alternative approach to the treatment of disease that is based on the belief that individuals suffer from illness because of an imbalance in what is considered the body’s optimum environment. Such an imbalance might be the result of a deficiency of a specific biochemical element such as protein, enzymes, amino acids, fatty acids, vitamins, minerals, dietary fiber or antioxidants. Treatment is typically via supplementation adjustments to the individual’s diet on short or long-term bases. Unlike many other alternative therapies, orthomolecular medicine is supported by medical science. While it’s considered beyond the boundaries of conventional medicine, its benefits are generally accepted by members of the conventional medical community. Orthomolecular medicine can allegedly be used effectively in the treatment of a wide variety of conditions from common colds to cancer. An orthomolecular practitioner will often use conventional medical terms to refer to a patient’s condition, but will explain the presence of that condition in terms of a deficiency of one or more elements. In order to address the deficiency, patients are often required to take supplements containing high doses of the deficient element. Once the imbalance 59
  • 60. has been corrected, it’s believed that a disease or complaint will not reoccur if care is taken to ensure further deficiencies are avoided. Broad-minded doctors practicing conventional medicine may suggest orthomolecular medicine to patients for whom conventional drugs and treatment methods have proven unsuccessful.• Reiki Reiki is an alternative approach to the treatment and healing of disease and medical complaints that originated in Japan. It was introduced to the world in 1922 by Mikao Usui, a Tendai Buddhist who claimed he received reiki while undertaking at 21-day fast at Mount Kurama near Kyoto. Reiki is a practice that involves a significant spiritual element and has no scientific evidence supporting its philosophies. Practitioners claim to be able to heal the afflicted by moving their hands over the patient’s body and directing healing energy towards the affected area. Practitioners, who are referred to as reiki masters, claim they make use of an energy or universal ‘life force.’ This force is said to be constantly present, but only reiki masters have been trained to access it. This energy cannot be seen and its existence has yet to be validated by any modern scientific experiments or tests. In spite of this, the practice has a number of followers in countries around the world. The practice is allegedly beneficial in treating a wide variety of medical conditions but is generally associated with relieving stress and localized pain, promoting better sleep, reducing blood pressure and the side effects of conventional drugs, supporting the immune system and accelerating the body’s self-healing abilities. These benefits are deemed to create a better environment for the body to recover from specific illnesses or diseases. 60
  • 61. Reiki is an unlicensed and unregulated industry. Currently in both the US and the UK practitioners are not required to be accredited. Patients choosing reiki as an approach to their medical complaint should make adequate enquiries about their proposed practitioner’s qualification before beginning treatment.• Siddha Medicine Originating from south India, Siddha is a form of medicine that is said to have been given to the Siddhars (yogic masters) by gods. Of 18 Siddhars mentioned in Indian history, Agasthiyar is said to have been the one chiefly responsible for establishing the philosophies of Siddha medicine. Siddha is an approach to medicine that incorporates a strong spiritual element, proposing that the health of the body and the soul are inextricably linked and the decline of one will ultimately lead to the decline of the other. Treatment therefore is intended to heal both entities and can only be administered by knowledgeable Siddha physicians. Siddha medicine shares some beliefs held by Ayurvedic medicine, citing the existence of three humors: vata, pitta and kapha. These humors are required to be balanced in order for an individual to achieve good health. Diagnosis is made by an examination that concentrates on eight aspects of the patient’s body: the general appearance, the tongue, the voice, the eyes, the skin, the pulse, urine and stool. The voice is judged on its pitch while all other aspects are judged by their color. Following diagnosis, a Siddha physician will prescribe herbs for the patient, choosing them on the basis of their abilities to balance the doshas (vata, pitta and kapha). Herbs are classified by means of five propertiea: suvai (taste), veerya (potency), guna (character), pirivu (class) and mahimai (action). They are further categorized according to their source, with those of herbal origin known as thavaram, those of inorganic origin known as thathu and those of animal origin known as jangamam. 61
  • 62. The efficacy of Siddha medicine has not been proven by any scientific methods and is hence largely dismissed by the conventional medical community. Some consider it to be a dying industry and Siddha clinics are rarely found in the west. Many individuals seek Siddha medicine when conventional medicine has failed to address their complaint. Siddha treatment is typically sought in India by an authentic and experienced Siddha practitioner.• Unani Medicine Unani medicine is an alternative approach to medical treatment that is practiced largely in India and whose principles are not dissimilar from those of Ayurvedic medicine. The philosophy behind the approach is said to be based on the teachings of Hippocrates, Avicenna and Galen. Unani medicine holds that the human body is comprised of four humors that determine an individual’s personality, body type and other mental and physical characteristics. These four humors are: balgham, which corresponds with phlegm; dam, or blood; safra, or yellow bile and sauda, or black bile. Sickness and disease are said to result from imbalances in these humors. A Unani practitioner will diagnose a patient’s condition in terms of a surplus or deficit of one or more of the four humors and attempt to address symptoms and ultimately cure a condition by administering herbs capable of reestablishing harmony between balgham, dam, safra and sauda. Herbs used are very similar to those used in Ayurveda treatment and similarities are often drawn between the concept of the four humors and that of the tridosha system in Ayurvedic medicine. Besides the use of herbs for treatment, Unani medicine employs a variety of other techniques intended to cleanse the body and restore humor balance. These techniques include: mushil (purging), taareeq (sweating), hammam (bath therapy), munzij (ripening), mahajim (cupping) and riyazat (exercise). 62
  • 63. Of these, purging is among the most common as Unani medicine often considers imbalances to be the result of metabolic changes in the body. Mushil attempts to convert the impurities formed from these changes into tangible matter that can be expelled from the body by the purging process. Outside of India, Unani practitioners can be difficult to locate. The US has a small number, some of which have been trained at the American College of Unani Medicine. However, since there is no regulation of the industry, practitioners are not required to have any formal teaching or qualifications in the discipline.• Yoga Yoga is a term encompassing a wide variety of practices that originated in India, many of which are profoundly different in their execution but are united by the fact they share the same fundamental philosophy. The word ‘yoga’ is a derivative of the Sanskrit word yuj, meaning ‘union.’ It follows that the philosophy behind all forms of yoga is the pursuit of union between an individual’s consciousness and what is referred to as the ‘universal consciousness.’ The techniques practiced to achieve this union can involve physical or mental exercise, or a combination of both. The physical aspects of yoga are significant and tend to be the focus of the majority of classes given at fitness centers in Europe and North America. There are many branches of yoga, however, each adopting its own approach to achieving ‘union.’ Hatha is among the most common branches practiced in the west and is the form most associated with physical exercise and manipulations of the body. Other branches of yoga include: Karma, Jnana, Bhakti and Tantri. Hatha yoga involves students performing a series of movements or postures known as asanas, combined with complex breathing techniques known as pranayama (a term meaning ‘breath of life’). Yoga classes in the west invariably focus on Hatha yoga and often incorporate a routine of poses known as surya- 63
  • 64. namaskar, or ‘sun salutation.’ Sun salutation in its basic form involves the samestages as asanas, although some teachers like to vary these stages by adding extraposes or repeating certain poses in the series. The benefits of yoga are widely acknowledged, not only by proponents ofalternative medicine, but also by members of the conventional medicalcommunity. Mental benefits include increased ability to concentrate and relieffrom stress, depression and anxiety. Physical benefits include increase strength,flexibility and mobility, relief from localized pain, a lowering of blood pressure,improved circulation and better cardiovascular health. Yoga Meditation 64
  • 65. 12. Alternative Medicine Treatments in India One of the most famous destinations for alternative medicine and therapies andwith cost-effective prices, India offers a wide range of unconventional treatments thathave been praised by patients from all over the world. The country draws a large numberof tourists each year who are solely after alternative therapies. Believed to be the ultimate way of achieving Enlightenment, yoga has beenpracticed for thousands of years in India. There are many retreat centers that offer thisideal meditation, which is considered to improve the health and well-being of thepractitioners. The main destinations for yoga centers in India are Rishikesh, on the lovelybanks of the Ganges, where many ashrams are cheap and peaceful, and Kerala, anupcoming destination. Another famous alternative therapy in India is Naturopathy, which is a holistictherapy that relies on natural remedies. Acupuncturists, Ayurvedic practitioners and othertherapies all employ naturopathy in their treatments, including detoxification and colonicirrigation. Naturopathic doctors can be found in many hospitals around the country. Thedoctors will perform a physical examination to treat an illness, both mental and physical. India also has a growing number of spas and health centers that offer massage,meditation, yoga and herbal medication, all of which are based on Ayurvedic medicineand exercise. There are a large number of licensed Indian healers and yoga trainers acrossthe country while Ayurvedic spas have sprung up everywhere in India, with the mostfamous being in the states of Kerala and Tamil Nadu. Because of its very affordable prices, India has attracted many tourists to itsalternative medicines and unconventional therapies. Most of these establishments boastmodern facilities and optimum services while all specialists have had years of experience.Visitors can also indulge in the country’s rich culture and explore the historical delights. 65
  • 66. 13. Health Tourism in India India’s health tourism epicenter is situated in its healthiest state, Kerala. The lifeexpectancy of locals here is higher than in other parts of India (approaching that of manyWestern nations), and the health-care system receives regular international praise. Surprisingly, traditional medicine namely Ayurvedic therapy is still widelypracticed here, presenting visitors with a unique opportunity to experience the revitalizingpower of this ancient medicine. A number of up-market ayurvedic resorts cater to touristswith in-depth treatment plans drawn from ancient Kerala traditions. Ayurvedic therapy blends artful massage and herbal remedies to treat a range ofmedical conditions including diabetes, hypertension, arthritis, ulcers, psoriasis, asthma,anxiety and simple back pain. Beyond its physical benefits, ayurvedic treatment is alsotouted as a means of rejuvenating the mind and the senses. A unique branch of ayurvedic therapy is known as Sirodhara, in which a streamof oil or medicated milk is gently poured over the patient’s forehead. The act helps tocenter the patient, providing relief from stress-related ailments and disorders of thenervous system. Western-style health spas are also widespread in India, though they emerged onthe scene much more recently. Many upscale hotels operate their own spa facilities inlarge cities like New Delhi, while all-inclusive health spa resorts dot the Indiancountryside. Steam treatments, massage and aromatherapy are commonplace in these facilities.Many visitors (both medical and mainstream tourists) pause for an opportunity to pamperthemselves while visiting India. Anything from a 30-minute facial to a weekend sparetreat is easily arranged. Yoga’s roots are planted firmly in Indian culture and there are countless institutesthat offer courses for tourists. Monastic retreats in rural India focus on honing body, mindand spirit through complex yogic instruction and meditation. 66
  • 67. The finest wellness resorts in India blend all of these treatments and traditions intoa single experience. Health retreat packages often include consultations with aruvedicdoctors, intermittent massage therapy, thoughtfully-arranged menus and in-depth yogainstruction. These all-inclusive health tourism packages involve some of the finest holistictreatment in the world, though they are made available at a fraction of what they wouldcost in Western nations. They offer benefits to patients in recovery, to those whommainstream medicine has failed, or to holiday makers simply looking for an opportunityto indulge. Ayurveda 67
  • 68. 14. Ayurveda & Health Tourism Also referred to as Ayurvedic medicine, Ayurveda (meaning ‘knowledge of life’)is an alternative medical approach that originated in India. It’s uncertain what period ofhistory the philosophy was conceived, but historians speculate that it’s probably severalthousand years old in its simplest form. Ayurveda is a holistic medical approach that considers both body and mind andtheir relationship to each other when diagnosing and treating a patient. The philosophyholds that we are all comprised of three essential abstract elements or properties, whichAyurveda refers to as doshas. The three doshas are: vata, pitta and kapha, and the degreeto which each presides in us may determine our physical and mental characteristics. Ayurveda views disease and physical ailments as imbalances in the three doshas,or the tridosha system as it is otherwise known. Treatment is therefore a means ofrebalancing the system and reestablishing harmony in the body. The philosophy holdsthat this can be achieved through various techniques which include the consumption ofAyurvedic herbs, the administration of special forms of massage, the adaptation of aspecific diet, the practice of yoga and regular exposure to certain elements of nature. Having long been popular in Asia, Ayurveda is becoming increasingly popular inthe west. Ayurvedic practitioners can assist with specialized treatments, but patients needto be aware of the specifics of their own tridosha system and the elements of theirlifestyle that can aggravate it, in order to ensure that further imbalances are not created. The philosophies of Ayurvedic medicine have no scientific basis however manyAyurvedic treatments are unquestionably profoundly soothing and relaxing. The methodsof purifying the body known as panchakarma are widely acknowledged as having obvioustherapeutic properties including improved circulation; relief from pain, stress andinsomnia; increased flexibility and improved athletic performance. 68
  • 69. 15. Herbal Medicine & Health Tourism Also commonly referred to as herbalism and sometimes as botanical medicine,herbal medicine is an approach to the treatment of diseases and medical complaintsinvolving the use of plants and their extracts. While herbal medicine treats conditions with the use of plants, many conventionaldrugs also use medicines derived from plant sources. However, herbal medicine isconsidered an alternative medical philosophy, as the efficacy of many of the ingredientsused has not been scientifically proven. Furthermore, many plant extracts recommended by herbalists have not beenapproved for use as medical aids and can only be sold under the classification of ‘dietarysupplement.’ In the US such products are prohibited by the Food and DrugAdministration (FDA) from making therapeutic or health claims on their labels. Herbalism is not a new phenomenon with many now popular supplements such asGinseng, Gingko and Valerian having been used for medicinal purposes for thousands ofyears. People in China, India and parts of South America have long made use of certainplants, their fruit and their roots for medicinal purposes while developed countries havetypically relied on conventional laboratory-derived medicines. In herbal medicine everyday ingredients, which in the west are commonly onlybeen used for their flavors and cooking properties, are exploited for their therapeuticbenefits. Cinnamon is taken to lower blood sugar levels, garlic to boost immune systemsand lower cholesterol levels, turmeric as an anti-cancer and anti-bacterial agent andginger as a treatment for nausea, gastric irritancy and joint pain from arthritis. Two of the most respected alternative medical philosophies from the east, Chineseand Ayurvedic, make use of plants for their alleged therapeutic properties. Chinesemedicine sees herbs as capable of addressing imbalances in a patient’s yin (heat) andyang (cold). Herbs are selected on the basis of their warming or cooling properties. InAyurvedic medicine herbs are selected on the basis of their ability to increase or reducevata, pitta or kapha, the three humors said to be present in individuals. 69
  • 70. 16. Yoga & Health Tourism Yoga is a term encompassing a wide variety of practices that originated in India,many of which are profoundly different in their execution but are united by the fact theyshare the same fundamental philosophy. The word ‘yoga’ is a derivative of the Sanskrit word yuj, meaning ‘union.’ Itfollows that the philosophy behind all forms of yoga is the pursuit of union between anindividual’s consciousness and what is referred to as the ‘universal consciousness.’ Thetechniques practiced to achieve this union can involve physical or mental exercise, or acombination of both. The physical aspects of yoga are significant and tend to be the focus of themajority of classes given at fitness centers in Europe and North America. There are manybranches of yoga, however, each adopting its own approach to achieving ‘union.’ Hatha isamong the most common branches practiced in the west and is the form most associatedwith physical exercise and manipulations of the body. Other branches of yoga include:Karma, Jnana, Bhakti and Tantri. Hatha yoga involves students performing a series of movements or posturesknown as asanas, combined with complex breathing techniques known as pranayama (aterm meaning ‘breath of life’). Yoga classes in the west invariably focus on Hatha yogaand often incorporate a routine of poses known as surya-namaskar, or ‘sun salutation.’Sun salutation in its basic form involves the same stages as asanas, although someteachers like to vary these stages by adding extra poses or repeating certain poses in theseries. The benefits of yoga are widely acknowledged, not only by proponents ofalternative medicine, but also by members of the conventional medical community.Mental benefits include increased ability to concentrate and relief from stress, depressionand anxiety. Physical benefits include increase strength, flexibility and mobility, relieffrom localized pain, a lowering of blood pressure, improved circulation and bettercardiovascular health. 70
  • 71. 17. Meditation, Meditation Retreats & Health TourismMeditation is a practice in which an individual seeks to achieve an advanced mental statethrough a process involving the removal of all natural thought processes other than thoserequired to focus on a single object or action. The practice is closely associated withBuddhism and is believed to have been around for more than 5,000 years.Meditation is considered to be beneficial to both mental and physical health in a numberof ways. Many proponents of the practice claim to have conquered illnesses ordebilitating medical conditions through meditation. The relief of stress, anxiety anddepression are deemed the most obvious mental benefits of regular meditation, whilephysical conditions such as irritable bowel syndrome, eczema, high blood pressure andasthma can be improved through meditation.Meditation can be difficult for complete novices and guidance through a meditationretreat is often a beginner’s best introduction to the practice. Retreat centers are invariablyaffiliated with one or more specific religions or philosophies such as Buddhism or RajYoga, and students can choose between them depending on their own personal beliefs orleanings.The most popular form of Buddhist meditation known to westerners is Vipassana (thelesser known alternative is Samatha) and is a practice that is offered in many centers inNorth America and Europe. Typically, students remove themselves from regular life for aperiod of 10 days or more, during which time the greater part of their day is dedicated tomeditative practice.For an authentic Vipassana experience many students travel to Asian countries such asThailand, where they are able to immerse themselves in meditation without any of thedistractions or temptations that western life might present. Students are generally assigneda mentor who is responsible for guiding him or her through the retreat and providinginstruction into the complexities of meditation processes.Once students have completed their retreats or instruction they can take away what theyhave learned and attempt to integrate regular meditation sessions into their daily lives inthe hope of achieving and sustaining good physical and mental health. 71
  • 72. Part – II A Research on Health Tourism 72
  • 73. 18. Research DesignStatement of Problem: After the detailed review of literature and examining the research gap, thestatement of problem for study is “Health tourism in H.P”Need of the Study: Since the ages Himalaya is a major destination for the travelers whether forleisure, adventure, pilgrimages or as a spiritual centre or a study centre or a place of anyother activity. But after the British involvement in the area this Himalaya becomesimportant place as a health resort. But after independence tourism has increased to agreater extent in Himalayan region and became a source of employment and income forthe people. Tourism is the world’s largest industry, promotes increased interaction ofpolitical and economic forces within a society. It may be regarded as consisting oftourists, a business, and an environment or community in which it operates. And thistourism phenomenon affects all these elements. These days tourism has been identified asthe tool for the development. Himachal Pradesh is known for its lush green nature, snow caped mountains,peaceful and non-polluted environment. And most of the tourists visit Himachal Pradeshfor health purposes, just for a change from their daily hectic schedule of life. Most of thetourist need extra activities for the purpose of health improvement and thus search for thesame when they visit Himachal Pradesh. Therefore, there is a greater scope of Healthtourism in Himachal Pradesh, which requires attention by the planners of the policies. Butthere is no study has been undertaken specifically on the health tourism. Hence the needis to undertake a study upon the health tourism and to study the various problemsassociated with this form of tourism.Nature of the study: This is an exploratory study which attempts to analyze various factors that effecttourism in the state capital of H.P. with the help of questionnaire. The study basically concentrates on analyzing a tourist’s needs, preferences,perceptions and satisfaction. 73
  • 74. Scope of Study:Focus: The study will be focused upon Health Tourism in Himachal Pradesh. Study willbe aiming at finding out the need and current status of health tourism in HimachalPradesh.Area: The study will cover major tourist destinations of Himachal Pradesh.Main objectives of the study: This study is to introduce you to the different aspects of Health tourism and theway it operates. The study will help us to understand the Health tourism and Medicaltourism and their importance in tourism industry.After having studied this research, we will be able to-• Pin-point and discuss the essential elements of Health tourism, and role of these elements• Identify the concept of health.• Identify different types of health activities and their relevance with health & tourism.• Discuss the impact of Health tourism.• To find the tourism trends and existing infrastructural facilities (Resource Inventory) at tourist places of Himachal Pradesh• To find out the Economic impact of Health tourism on local community in terms of revenue, employment in the area due to tourism etc.• To identify/develop suitable models for the development of community due to religious tourism.• To identify the role of Government in Marketing of Religious Tourism in Himachal Pradesh. 74
  • 75. 19. Research Methodology: Methodology involves the knowledge and use of tool and techniques in socialresearch is to collect reliable data to as certain the truth or build the theories. Socialscientists are equally emphatic in ascertaining that methodology involves the use ofscientific methods only. According to Webster dictionary methodology implies thesystem of methods any classification as it applied by art the study of proceduresfundamental to organization of the field of study through which the project will beconducted. The pronouncement and background data for research is mostly to be obtainedfrom various documents and administrative reports and some of various journals,newspapers and hand book will also be contribute much formed and informed interviewswill helps the study. In accordance with the problems to be researched andappropriateness of the techniques of investigation research design has been classifiedbroadly as:-Exploratory Research Design:- The major emphasis of exploratory study is on the discovery of ideas and insights.The design is flexible enough to provide opportunity for considering different aspects of aproblem under study. Inbuilt flexibility in research design is needed because the researchproblem, broadly defined initially, is transferred into one with more precise meaning inexploratory studies which fact may be necessitate changes in the research procedure forgathering relevant data. Generally the two methods in the context of research design forsuch studies are talked about. 1) The review of concerning literature. 2) The primary surveyIn the present work resources these instruments are primarily undertaken. The review of literature, happens to be the most simple and fruitful method offormulating problem and generating the first perception about its solution work alreadydone by others, should be reviewed and on the basis of those new perception has to bedeveloped. 75
  • 76. Data to be used:Secondary Data:To achieve the first objective i.e., to find out the tourism trends and existinginfrastructural facilities we would use secondary data from following sources: 1. Published and unpublished records of health institutions. 2. Annual reports of tourism department. 3. Various books relating with the information about health tourism. 4. Journals (International journal of Management and tourism, Tourism Management, Annals of Tourism Research, Tourism Recreation and Research) 5. Magazines (Discover India, Monal, Safari India, Health Plus) Newsletters (Travel talk, travel trends Travel and tourism express etc.) and travel guides, newspapers and various Websites.Primary Data:Primary data has been collected with the help of questionnaire. A questionnaire has beenprepared for tourists.Through this information about the whole trip has been gathered including profile oftourists (age, sex, marital status, nationality, education etc.). Opinion survey of touristregarding quality of facilities, problems faced during the tour.Format of questionnaire:The questionnaire is made for the tourist containing major areas as:-Profile of the tourists:-This is very first section which tells about the place, age, marital status, occupation andeducational qualification of visitors. 76
  • 77. To identify the purpose of visit:-This section covers the purpose of tour, motivation behind the tours & length of stay.To know the nature of arrangements done:This covers the information of various arrangements happened during the tour.To study the opinion on various travel and stay related services:-This show satisfaction level of client who used certain services during the tour.Total sample size:-Total response from tourist-30Sample Size and Sample Design:-Methods of data collection largely depend on the nature of research work. Beforecollection of data one has to work over the sample technique and its accessories.Qualitative approaches to research, which the researcher has opted for, demand differenttype of sampling techniques from those commonly used in qualitative study. Beforechoosing the sampling technique, it is necessary to justify why sampling is required inthis particular case study research method. In general term sampling enabled theresearcher to study a relatively small number of units in place of the total population andto obtain data that are representative of whole target population. This provides substantialadvantage. Firstly, because in many cases complete coverage of the population is notpossible, by peeping through a smaller section the purpose may be served. Secondly,sampling, besides being economical also saves a lot of time and energy.On the basis of representative quality, sampling can be divided in two groups, theprobability sampling and the non-probability sampling. 77
  • 78. Among the probability sampling the main typologies are:- i. Sample random sampling. ii. Systematic sampling. iii. Stratified random sampling. iv. Cluster sampling. v. Multi stage samplingAnd non-probability sampling covers:- i. Accidental sampling ii. Purposive sampling iii. Quota sampling iv. Snowball sampling.The probability sampling techniques are used in those situations where accuraterepresentation, high reliability is reburied, because the purpose of study is generalization.The non-probability sampling techniques are lying in the opposite pole. They arecommonly used for exploration and qualitative analysis. Since the researcher’s mainfocus is in providing insights about the religious tourism as a tourist destination, thechoice of non-probability sampling is justified.Analysis and Interpretation of Data:Keeping in view the study the data collected have been analyzed and interpreted with thehelp of following tools:- 1. Statistical tools. 2. Mathematical tools. 3. graphical methods 78
  • 79. Mathematical Tools:In the present study the data collected was analyzed with the help of mathematicalmethod such as simple average method and percentage method. Further method ofweighted arithmetic mean was used in the study.Statistical Tools:Statistical methods provide an indispensable tool for collecting, organizing, analysis andinterpretation of data, expressed in numerical terms.a. Descriptive statistical measures:They are used to describe the characteristics of the sample or population in totally. Theylimit generalization to the particular groups of individual observed or studied. Thestatistical analysis based on the computation of descriptive statistical measure is mostlyapplied in action research and provide valuable information about the nature of aparticular group weighted automatic mean method has been used in this study.Graphical Methods:In the present study the data collected have been analyzed with the help of graphs whereneeded in the following ways:I. Bar diagramII. Pie diagramLimitations of Study:Studies are confined to particular geographical area, in the tools and techniques applied,in sample and procedures and so on depending on researcher’s resources. • The sample size may not be very large to generalize the result. • The sample may not be a true representative of the entire population. • It is limited to information on both by primary and secondary data. • The time and expenditure too were the strong limitation for the researchers. • Due to lack of resources it will not be possible for researcher to visit all places. 79
  • 80. Contribution from the present study: This study will be dealing with the tourist places as health interest for visitors andtourists and with the issues, which it raises. It will concern with tourist places, which hasconnections with health and its related activities. The study will also try to find out theproblems related with the health tourism. Due to sensitivity and conservation, control ofsome kind are invariably needed and here the responsibility lies with central and localgovernment as well as for the management of these sites as they attract a large numbers ofvisitors. This study will find out the impact of health tourism in the development ofcommunity and it will draw out the various issues related with it. As India and Himachalgovernment is seriously thinking of developing health tourism so here comes theresponsibility of the academicians to help them in planning and hence the present studywill be important for planning the health tourism in a systematic manner in order to gaineconomic, social and cultural gains. Even in the time when international tourism is facing huge challenges in the wakeof terrorism and the war, planning and the emphasis on the regional travel is the need ofthe hour. Himachal Pradesh is the state with a lot of potential for the domestic as well asinbound tourism. To make it more economic efficiency oriented, more studies requiredfor its proper management, before it gets deteriorated. Hence this study on impacts ofhealth tourism for the development of community is quite important in contemporary era. 80
  • 81. 20. Case Study in Health Tourism Traditionally, the Indian healthcare sector was ailing due to several factors like thelack of medical awareness, low penetration of medical insurance, low doctor topopulation ratio etc. However, it has come a long way and has witnessed a robust growthin past few years on the back of increasing healthcare campaign, increasing medicalinsurance coverage, rising income levels and a rise in medical tourism. India still lagsbehind in health related infrastructure in the primary health care sector, when compared toother developing nations. According to CII-Mckinsey study on Health in India, India isexpected to spend US$ 45.76 billion on healthcare in the next five years. Currently, thehealthcare industry is witnessing changes in-patient demographic profile accompaniedwith several lifestyle diseases hitherto unknown. Travelling to other countries to obtain Health, Medical, Dental, and surgicaltreatment is called Health/medical tourism. As the cost and waiting time for healthtreatment has increased in many developed countries, many people view this service as aneffective and reliable alternative to expensive private health care in the home country.Many combine their treatment with the holiday to their destinations hence the term“Health Tourism.” Health Tourism (also called as medical travel or health tourism) is a term initiallycoined by travel agencies and the mass media to describe the rapidly growing practice oftravelling to another country to obtain health care. More recently the phrase “GlobalHealthcare” has emerged and may replace the earlier terms. Such services typicallyinclude elective procedures as well as complex specialized surgeries such as jointreplacement (e.g. knee / hip), cardiac surgery dental surgery and cosmetic surgeries. Theprovider viz. the hospital and the customer use informal channels of communication-connection-contract with less regulatory or legal oversight to assure quality and les formalrecourse to reimbursement or redress. In addition, to the hospital procedures, leisureactivities are also typically associated with this treatment. Thus travel and tourism aspectsare also included in this health travel trips. 81
  • 82. The health tourists mainly come from the rich and the developed countries like theUSA, Canada, UK, Middle East, Japan etc. mainly because of the high cost of thehealth/medical treatment as well as the high waiting time (for e.g. up to one year).Additionally in some of these countries, certain types of treatment e.g. orthopaedicsurgery (hip / knee replacement) are not covered by the respective health insuranceschemes. The patient then has no choice but to use the services of the Indian or otherhealth tourist centres. Popular health/medical tourist destinations include India, Brunei,Cuba, Columbia, Hong Kong, Hungary, Jordan, Malaysia, Singapore, Thailand etc.Research Objective DefinedThe objective of the paper is to • Understand the key issues and challenges that a hospital faces in promoting medical tourism and • To suggest action plans, this will help the hospitals in promoting medical tourism.Research MethodologyThe research methodology used for the purpose of this study was essentially anexploratory research, wherein the hospitals, the medical tourist patients as well as theagents / tour operators in India and abroad were contacted and issues discussed. A total ofaround 35 such personnel were contacted. The break up of these personnel was asfollows: 82
  • 83. The duration of the study was around 4 months. Both primary data and secondarydata were used. The primary data consisted of a pointer driven questionnaire administeredto around 35 personnel, while the secondary data consisted of books and other sources ofinformation. It must be understood that the industry is still in its infancy and hence noreliable data is available. Additionally in some of the medium sized and bigger hospitals,the doctors and administrators are not willing to speak about it since a divorce existsbetween the doctors and the persons viz. tour operators who organize the trip.FindingsGlobal ScenarioAs mentioned earlier, the main driver for patients to visit medical tourists countries likeIndia, Singapore etc is the high cost of the treatment as well as the long waiting period –as long as one year. The total global size of the medical tourism industry is not reliably available,however the discussions with several knowledge persons indicated that the five majorcountries viz. India, Jordan, Malaysia, Singapore and Thailand have reported about 2million medical travellers in the year 2004. It is estimated that on an average a medicaltourist spends aprox. US$ 362 a day vis a vis a normal spend of US$ 114. The major players in the medical tourism are the Apollo Group of Hospitals(India), Escorts Heart Institute (India), the Bumrungrad Hospital (Thailand), SunwayMedical Centre (Malaysia) and the Raffles Hospital (Singapore). Almost all thesehospitals have upgraded their interiors to resemble five star hotels. The hotels have alsotied up with travel agents / tourists so as to facilitate a comfortable and hassle free travelfor the over seas patients. Additionally all the governments have started a promotion of aggressivepromotion to boost the sector in the respective countries. 83
  • 84. Hong KongHong Kong has around 12 private hospitals and more than 50 private hospitals. All the 12hospitals have been accredited by the UK’s Trent Accreditation Scheme.MalaysiaMalaysia has plans to develop itself as a medical tourism hub. The country has excellentinfrastructure and most important English is widely spoken. Malaysia has its own nationalaccreditation scheme (MSQH). Again the Association of Private Hospitals in Malaysia isworking to develop medical tourism.New ZealandNew Zealand is a relatively new player in the medical travel market focusing mainly onnon acute surgical procedures and fertility treatment. The cost of treatment in NewZealand (inclusive of Air travel, accommodation etc) is expected to around 40% of thecost of the US and the UK cost.PhilippinesThe Philippines is another country which is making great strides in the area of medicaltourism. The medical centres in Metro Manila have complied with ISO standards andhave received accreditations from the Philippine’s Department of Health, JointCommission International (JCI) of USA etc.SingaporeSingapore Medicine is a multi agency government initiative that aims to developSingapore into a leading destination for health care services. In 2005, aprox. 3,74,000medical tourists visited the country. Most of the patients were from the neighbouringcountries like Indonesia, Malaysia etc. 84
  • 85. Indian ScenarioMedical tourism market in India is estimated to be around US $333 million (in 2004),accounting for around 1,50,000 patients mainly from US, Britain, Gulf, Africa and theSouth Asia Association for Regional Cooperation (SAARC) nations and growing at therate of more than 25% p.a. Currently there are more than 2000 hotels in the A Gradecities which can provide an accommodation of approximately 1,00,000 rooms, which isvery well equipped to cater the growing needs of this segment.Three players dominate the Health tourism sector viz. • Tour Operators, • Hotels, • Hospitals and / or integrated hospitals cum hotels. For Health tourism to succeed a consortium of Tour operators, Hospitals andHotels (if an integrated set up is not available) is a must. The purpose of these touroperators / agents is to liaise with the insurance companies and the private / publichealth/medical practitioners in the European and American markets, so as to ensure asteady stream of patients. In addition, the tour operators also help in explaining theproblems that the patients may face when they visit India. (For e.g. the unhygienicsurrounding, the non-availability or inadequate transport system etc.) The cost of the touroperators can be as high as 15 to 20% of the total cost of the service offered. Thus fore.g., the cost of the tour operator could be 15 to 20% of say US $ 69200/- (Cost of a bonemarrow transplant in India) or 15 to 20% of say US $69350/- (Cost for a Liver Transplantin India). Additionally, while the hospitals SELL the medical services, the hotelsSELL India as a tourist destination using the ploy of selling “EXOTICA” (or e.g. thetraditional therapies and treatments of Kerala). Price is the major selling point. The costof an open heart surgery could be around US$ 150000 in USA or US$ 70000 in UK,while the cost of the treatment in India could be as low as US$ 3000. 85
  • 86. The following table gives a very brief comparative picture of the price of the treatment.Similarly the cost of hotel plus hospital is quite low. ThusKerala has been very successful in medical tourism. The presence of several tourists spotslike the Alappuzha Beach, Kappad Beach, Kovalan Beach, Marari Beach, or PeriyarWildlife Sanctuary, Tekkady Wild life Resorts etc and the ancient art of treatments hasmade Kerala very successful in medical tourism. 86
  • 87. Some of the treatments essentially Ayurveda involves • Ayurveda Abhyangam (14 days treatment) • Dhanyamla Dhara (14 days treatment) • Dhara (14 days treatment) • Kativasthi (14 days treatment) • Kizhi (14 days treatment) • Nasyam (14 days treatment) And many many moreMarketing Communication plays a very major role – Word of Mouth communication.Tie-ups with the leading medical insurance companies also help in reducing the cost ofthe tour operators. Additionally tie ups with foreign universities – wherein internship isoffered in India also helps in securing medical tourists to India. From the customer’s perspective, i.e. the medical tourist’s perspective, the keydrivers which motivate a patient to travel to India for medical purpose are: • Availability of hospitals with International accreditations like “Gold Seal” • Treatment provided is comparable to any other destination in developed countries • English speaking doctors. • Connectivity is good • Possibility of on line diagnosis especially for post care and future consultations. • Large pool of doctors (Over 650,000) • Nurses & paramedics – Highly skilled experts with good communication skills. • Strong Pharma Sector and gaining worldwide recognition. • Yoga & Kerala Ayurveda as alternative treatments. (In case of minor ailments) • The easy availability of major tourist destinations like Goa, Agra, Jaipur, Kerala and Himachal Pradesh etc. (This serves as an additional incentive to the Health tourist). 87
  • 88. In India, Apollo Hospital has been a forerunner in attracting medical tourism in India. Onan average it attracts around 95000 tourists many of whom are of the Indian origin. Thegroup has tied up with hospitals in Mauritius, Tanzania, Bangladesh, Yemen and SriLanka. Escorts claims to have doubled its number of overseas patients. Ruby hospitals inKolkata have signed a contract with the British Insurance Company (BUPA). From the Hospital’s point of view, medical tourism is an area, where greaterprofits can be made. This profit can be utilized for making their service affordable to thelower segments of the society or otherwise. For the hospital, profits are to be made in twoareas: a. In the treatment offered to the medical/health tourist and b. In the areas outside the treatment e.g. the room offered, the food offered, the laundry services offered etc. etc. In the areas where treatment is offered, the presence of Operations theatres,equipments etc, which are comparable to those available in the developed world, are adefinite advantage. This area however does not yield great profits. The key issue in Health Tourism is differentiation in the service offered to theHealth tourist from the domestic tourist. From the hospital perspective, health touristsneed to be provided a “More Than DELUXE Service – an area where customer centricityis a must. Such “More than Deluxe Service” can be offered at a premium price withmarginal costs to the hospital. The detailed discussions indicated that the cost to the hospital is extremelymarginal in upgrading the economy room to More Than DELUXE Room, which isoffered to the customer. The cost of converting an economy room to a More than DeluxeRoom is an additional 20%, while the tariff charged is more than 300% to 400%. 88
  • 89. From the hospital’s perspective, food served to the health/medical tourist isdifferent from that served to the normal domestic patients—an area where again profitscan be made. The health/medical tourist is normally accompanied by two or three relatives, whoneed housing—quite close to the hospital or better still within the hospital premisesitself—another area where again profits can be made. The pre and post operative care is another important area where profits can bemade. Thus from the hospital perspective, along with quality treatment, a host of areasexists where profits can be generated. There are a number of challenges faced by this industry ranging from competitionfrom other developing countries like Singapore & Malaysia to unhygienic standardsoutside hotels and hospitals resulting in common infections. For the hospitals therefore the key issues is marketing the concept of medicaltourism to the developed countries, providing quality services both pre operative, postoperative and the other incidental services which are provided along with the treatment.Innovative ideas like offering a total package which includes medical services plustourism packages are the key areas for success. 89
  • 90. 21. Designing the Health Product Once you decide on the destination and the health care service that you are goingto offer, getting the right product mix will ensure that you get maximum returns on yourinvestments in terms of money and efforts. To decide on your product mix you need toconsider whether you would: • Be providing specialized services. For example, Ayurvedic Centres for heart patient, acupuncture centres for back problems, etc., • Be situated right in the heart of town or outside the city limits. For example, say health care centres in the heart of town/city for the chronic patients looking for rehabilitation and who cannot travel far, and • Have a new product and create a market for it or work out a niche for yourself in the existing market. For example, anti-ageing clinics are always a hit. Once you decide on the product or type of product you want, product designingcomes in. Product designing helps you to give the desired shape to your product/serviceand decide on the product mix. The best approach to design tourism products/services isto distinguish between the core and the supporting attractions. Core attraction is thebasic need a service provider is trying to provide for while supporting attractions are theancillary services associated with the basic need. We will approach the designing of a tourism service on the basis of the fiveproduct levels as mentioned by Philip Kotler. Let us again consider the example of ahealth resort which is economically viable. The need was felt specifically for a health carecentre providing treatment of minor ailments and rejuvenation packages. Theproduct/service to be provided was decided upon as an ayurvedic package. So the fivelevels would be: 90
  • 91. LEVEL 1 CORE BENEFIT Rejuvenation PackageLEVEL 2 GENERIC PRODUCT Ayurvedic Centre Ayurvedic treatment with herbs and oils, EXPECTEDLEVEL 3 Qualified practitioner / expert, food, PRODUCT accommodation Various Rejuvenation Programmer (Rasayna Chikitsa, Kayakalp Chikitsa, Sweda Karma and AUGMENTEDLEVEL 4 others), Qualified and Expert Practitioners, PRODUCT Accommodation in AC Rooms or cottages, Multicuisine Restaurant Gymnasium, Herbal Steam Bath, Medicated Pool, Mineral Bath, Herbal Garden, Indoor and POTENTIAL Outdoor Games, Accommodation with treatmentLEVEL 5 PRODUCT rooms and kitchen, Multi-cuisine Restaurant providing food of your choice or diet food as advised by the doctors, etc. The above model shows the step by step process to design a product. Identifying aneed and then adding various additional attractions lead to the designing of a product orservice. Providing the extra gives you the edge over your competitors. In the modernservice industry, more value additions are given to attract and retain customers. Forexample, one of the health cares in Kerala provides a combination of services. The centreis accessible from Cochin or Calicut airport and according to their 108 website; it issituated in the beautiful countryside of Kerala. Their product design combines all theattractions mentioned in level 5 along with trips to local tourist spots, elephant camps, etc.Also resident and visiting doctors provide consultation and supervise treatments. ( 91
  • 92. Let’s now consider another example dealing with another aspect of health tourism,namely ‘rehabilitation’. Rehabilitation is mainly after a person has undergone someserious illness, but this term is very commonly used only in context of the people who arechemically dependent. As the case may be, the tourist in question could be a post-operative patient or someone recovering from a bout of serious illness or accident. So,while designing the product, the levels can be:LEVEL 1 CORE BENEFIT RehabilitationLEVEL 2 GENERIC PRODUCT Rehabilitation Centre EXPECTED Medical facilities, Doctors on call, Nurses,LEVEL 3 PRODUCT Accommodation and food. All types of Medical Facility (Labs, OT, latest gadgets, CT Scan facilities, etc.), both Resident AUGMENTED Doctors and visiting Experts, 24 hoursLEVEL 4 PRODUCT Observation under specially trained and experienced nurses, different types/categories of accommodation and food. World Renowned Medical Consultants, Special Units for different illness, Counseling sessions POTENTIAL with psychiatrists, natural beauty of the areaLEVEL 5 PRODUCT surrounding the clinic, trips to local attractions, health building exercises with physiotherapists, etc. From the above example we can see that to arrive at the right product mix, oneneeds to have an in depth knowledge about the services associated with the product weare planning to design or sell and only then one can decide upon the supportingattractions/ancillary services that goes with a basic or core service. Getting the rightproduct mix will ensure that we get maximum returns, the prime motive behindrunning/any enterprise. 92
  • 93. 22. Developing and Positioning of the Health Tourism Product Once you have decided on your product mix, its time for you to develop it andposition it in the market and finally create a niche. Developing the product/serviceinvolves developing the infrastructure to sustain the tourist flow and also the productwhile developing a product we need to consider the following (Source: The TourismDevelopment Handbook , by Kerry Godfrey and Jackie Clarke):1) Product Life Cycle: One needs to consider all the growth aspects of the product.Just developing a product is not the beginning and end of the product development ratherproduct should be developed in such a manner that it sustains the tourist interest for along way to come.For example: Take the example of yoga and health packages in Rishikesh. So to developthe product for long term, let’s see the steps that will be involved:1st year Yoga classes special for beginners2nd year Yoga classes for curing specific ailments3rd year Yoga + Reiki4th year Yoga + Reiki + Ayurveda5th year Yoga + Reiki + Ayurveda + Spiritual upliftment talks and so on.We can keep on adding features to the above to sustain tourist interest.2) The Product Portfolio: This stage makes you consider the various aspects of theinterrelationship between revenue produced and resources used. For example, segmentingthe resources used according to the target market enables you to keep track of revenue 93
  • 94. and resources. Making Ayurveda packages to deal with specific ailment is an example ofthis.3) Relevant Gaps: One can add more to the product line and accordingly lengthen it ordeepen it. • Lengthen – by adding more products to an existing line, like spirituality, meditation, talks on yoga. • Deepen – by adding more product items such as specialty treatment in ayurveda and so on4) Analysis of Tourist Satisfaction: A check on the services provided should bemaintained by judging the tourist reaction to them. A check on tourist reaction helps onedecide on upgrading and providing better services. Regular feedback system throughquestionnaire or interface with tourists can always help you in improving or adding valueto your services.5) Development of Product Differentiation: The product should be distinct fromcompetitors and have an identity (branding). This would ensure that your product standsout to the tourist. For example, opening an ayurveda centre, complete with modern healthcare facilities and the essence of ancient baths of Romans would be more than anayurvedic centre and would be more of a health care centre. It is up to you as developer to distinguish the various product levels and come upwith a unique sustainable product so as to satisfy the identified market needs and receivequick returns on your investments.Once the product is developed, you need to introduce the product via proper promotionalmethods. This would ensure that the target market is made aware of the product and theproduct gets positioned accordingly. Product positioning is about reaching the targetmarket and creating a distinct identity as a product. For example, Kerala has positioneditself as Gods own land where God blesses the curators or medical practitioners torejuvenate the health of ailing suffering visitors. 94
  • 95. 23. Key players in Health Tourism1. Roles of Hotels One of the most common requirement for health tourism is a hotel. Hotels canprovide facilities of spa, massage centres, gymnasium, space for recreational activitiesand most importantly accommodation (rooms), food and beverage services for the touristswho visit a destination for the purpose of health. Typical hotels have accommodationrooms, restaurants, ballrooms, meeting rooms, swimming pools, a business centre andmore. In relation to Health activities, a hotel plays different roles depending on itsfacilities and the size of the health activities:1. Accommodation and meals for the tourist seeks health activities.2. Accommodation & meals to the persons accompany the main person who seeks health3. Facilities for health associated activities such as Spa, massage centres, Yoga & meditation centres, Gymnasium, swimming pools and other related services. Accommodation Food and Beverage 95
  • 96. 2. Role of Transport Transportation management covers routing, vehicle use, staff requirements, maps,signage and preparation. The cost of transportation will also have an impact on thenumber of tourists. For health tourism, transportation management is crucial like otherforms of tourism. Air tickets and ground coach bus tickets are also frequently used. International Major international transportation methods include flights, cruise ships and trains. For health tourism that involves international tourists, transportation plays a majorrole in determining the success of a tourist destination. Cities located near major air orland transport hubs have the advantage of being able to draw in more tourists. Whiletravelers can fly directly from New York to Delhi on a direct flight using Spicejet or BA,they will need to tack on surface (rail or road) trip to reach Himachal Pradesh. In suchcases, Delhi is more convenient due to its sophisticated and well-developed transportationnetwork. LocalOnce the travelers arrive at the airport, they can be connected via the local transportsystem. This includes transportation: • From the airport to the hotel • From the hotel to health activity venues (Hospitals or fitness centres etc.) • From venues to various site visit spots 96
  • 97. • From the hotel to the different attraction (sightseeing) • From the hotel to the central location • from the hotel to the airportCities offering different vehicles of public transportation enhance the travel experienceand increase traveller expense. Local public transports include: • Water – cruise ships, ferries • Land – limousines, taxis, buses, shuttle buses, trains, trams, cable cars3. Attractions and supporting Infrastructure • Attractions Although the main purpose for health travelers is to attend health relatedactivities, they would usually prefer to visit some of the local attractions. Most of thetime, tours are organized after the completion of health related issues by internationaltourists to visit the attractions in and near the destination. For some travels, visiting localattractions might even be the objective of the trip along with health related activities.Therefore, when deciding whether or not to visit a destination, health travelers may alsokeep local attractions in mind. An official travel agent involves in the selling of a health tour package willusually be contracted to organize the post health activity tour. This travel agent alongwith the venues of health related activities also takes care of the travel arrangements ofthe tourist, if necessary, by providing a local guide. • Supporting Infrastructures Infrastructure of a tourist destination supporting health tourism plays veryimportant role in the success of such destination. Health related infrastructure likehospitals and other health centres do play an important role but other services like safety& security (police), public transport etc., are the supplement to these activities and thesedepends on the development and planning of the city. 97
  • 98. • Technology Infrastructure There is every moment change in the technologies at this modern era. Adestination like Himachal Pradesh must familiar with the modern advancement in thetechnologies and equipments, used in health tourism.4. Role of Central / State Government Both central and state government plays an important role in the development of adestination as a Health tourism destination. It is their policies on their level which providesupplement to the growth of tourism.5. Role of Local community Local community always plays an important role for the growth of a touristdestination as they are the provider of the important services to the tourists. 98
  • 99. 24. SURVEY • GENDER OF TOURIST: Sr. No Gender No. of Respondent 1 Male 24 2 Female 6 30 25 20 15 10 5 0 Male Female Above graph shows that maximum respondents 30. (Male 24 and Female 6) 99
  • 100. • AGE WISE DISTRIBUTION: Sr. No Age No. of Respondents 1. 10-20 0 2. 20-30 16 3. 30-40 11 4. Above 40 3Above graph shows that maximum respondents i.e. 16 were of age group between 20-30,11 were of 30-40 and 3 were of above 40 years of age. 100
  • 101. • EDUCATION QUALIFICATIONS: Sr. No Education No. of Respondents 1. Metric 1 2. Graduation 11 3. Post-Graduation 18 4. Others 0Above graph shows that out of total respondents maximum were post graduates i.e. 18 ,11 were graduates and only 1 was metric. 101
  • 102. • OCCUPATION: Sr. No Occupation No. of Respondents 1. Services 10 2. Students 04 3. Business 09 4. Others 07Above graph shows that out of total respondents 10 were from services, 4 were students,9 were businessmen and 7 were from other sectors. 102
  • 103. • IN PURPOSE OF VISIT HP:Purpose of visit No. of respondentsAdventure 10Religious 08Health 07Honeymoon 05 10 9 8 7 6 Adventure 5 Religious 4 Health 3 Honeymoon 2 1 0 No. of respondentsAbove graph shows that 10 respondents had to came for adventure, 08 for religious, 07for health and 5 to honeymoon. 103
  • 104. • INFORMATION ABOUT DESTINATION:Mode of information No. of respondentsInternet 9Travel agency 8Advertisement 6Others 7Above graph shows that 9 out of total respondents got information about destinationfrom internet, 8 from travel agency, 6 from advertisements and 7 from other sources. 104
  • 105. • WITH WHOM TRAVELLING: Sr. No Travelling with No. of Respondents 1. Family 15 2. Relatives 04 3. Friends 10 4. Others 01Above graph shows that 15 tourists were visiting with their family, 4 were visiting withrelatives, 10 with friends. 105
  • 106. • Rate Himachal Pradesh as a Health Tourism Destination:Rate destination No. of respondentsVery Good 14Satisfactory 09Good 03None of all 04Above graph shows that 14 respondents had faced a very good, 9 with satisfactory, 3 withgood and 4 none of all. 106
  • 107. • HIMACHAL PRADESH IS BEST DESTINATION Destination No. of respondentsAgree 16Disagree 6Partially Agree 5No Idea 3Above graph shows that 16 respondents to agree and 6 respondents disagree and 5respondents partially agree and 3 respondents no idea. 107
  • 108. • Health tourism can make a key role for economy of the state : Health tourism can make a key role for No. of Respondent economy of the state Yes 24 No 6Above graph shows that 24 respondents Yes and 6 respondents No. 108
  • 109. • PROBLEM FACED BY TOURISTS:Problems No. of respondentsTransportation 17Accommodation 6F&B 3Others 4Above graph shows that 17 respondents had faced a problem of transportation, 6 withaccommodation, 3 with F&B and 4 faced other problems. 109
  • 110. Part – IIIHealth Tourism in Himachal Pradesh 110
  • 111. 25. HIMACHAL PRADESH – General InformationTourism ScenarioHimachal is situated in the heart of western Himalayas. Jammu and Kashmir in the North,Uttaranchal in the Southeast borders the state. Haryana in the South and Punjab in theWest. Himachal is located between 30022 and 30012 north latitude and between 75047and 7904 east longitude. Shimla, a beautiful serene city, is the state capital. HimachalPradesh became a full-fledged state of the Republic of India on January 25, 1971.The PeopleMost of the population of Himachal Pradesh is Hindu and Buddhist and people speakHindi, Punjabi, Urdu, English and the local Pahari dialects. The people lead a simple lifeand are very religious. The major tribes include the Gadis, Gujaris, Kinnauris, Lahulis,and Pangwalis.Transportation / Connectivitya) RoadDespite problems in constructing new roads and maintaining them, most of the importantplaces in the state are connected with a good road network. Some of the roads are closedduring the winter and monsoon seasons due to the heavy snowfall and landslides thatoccur regularly in this region.b) RailOnly few places in Himachal Pradesh are connected by trains, as the construction of newlines are very difficult in the rugged, high altitude regions. The longest railway line isfrom Pathankot in Punjab to Jogindernagar in Himachal Pradesh. Other railway trackstouch Shimla, Solan, and Una.c) AirThe state has three airports at Bhuntar, Gaggal, and Jubbarhatti, which connect the stateto Delhi and Chandigarh via regular flights by Indian Airlines. There is no internationalairport 111
  • 112. Tourist arrival in Himachal PradeshTable: Tourist inflow in Himachal PradeshTourists 2001 2002 2003 2004Domestic 5211772 4958917 5543414 6345069Foreign 135760 144383 167902 204344Total 53,47,532 51,03,300 57,11,316 5549413Source: India Tourism Statistics, 2003The major Tourist spots in Himachal Pradesh can be categorized into the following:Table: Tourism in Himachal PradeshS. Type of tourism PlacesNo. Barog, Chail, Chamba, Chamonda Devi, Dalhousie, Hamirpur, Dharamsala, Joginder Nagar, Kangra,1 Kinnaur, Khajjiar , Kasauli, Kufri , Kullu, Lahaul & Hill tourism Spiti, Manali, McleodGanj, Mandi, Narkanda, Palampur, Parwanoo, Renukaji, Shimla , Solan Baijnath, Manikaran, Poanta Sahib, Hatkoti, Masrur, Renuka, Dharamsala , Jawalamukhi, Nahan2 Religious tourism Lord Elgins Memorial (Shimla), Maharajas Palace (Shimla), Padam Palace, Vice Regal Lodge, Rang Mahal3 Heritage tourism (Chamba), Tabo Monastery (Spiti) 112
  • 113. Great Himalayan National Park (Kullu), Pin Valley Park Lahaul Spiti), Kalatop Wildlife Sanctuary (Khajjiar, Chamba), Bandli Sanctuary (Mandi), Nature Parks4 (Shimla), Churdhar Sanctuary (Solan Valley), Majathal Sanctuary, Pong Lake Sanctuary (Dharamsala), Daranghati Sanctuary (Rampur Bushahr), Kanwar Wild life tourism Sanctuary, Parbati Valley (Kullu), Simbalbara Sanctuary (Paonta Valley, Sirmour), Renuka Sanctuary (Nahan), Chail Sanctuary (Solan Valley) Adventure tourism Shimla, Kangra, Leh Overland, Markha Valley Trek, Manali - Rohtang Pass, Zanskar trek, Chadder Trek,5 (Trekking, Rafting, Sham Trek, Stok Trek, Pirdi Skiing) Shimla, Manali, Solan, Palampur, Tanda, Mandi,6 Health Tourism Kangra, DharamshalaProbable links / actors of the Medical / Health tourism service sector: • The traveler • Foreign tour operator • Indian hospitals • Insurance companies • Indian Travel Agents • Tourist destination/place • Local tour operator • Local guide • Local hotels • Local market 113
  • 114. 26. Health Tourism in Himachal Pradesh Bestowed with matchless natures splendour, Himachal Pradesh has for long beenproviding visual treat to the visitors. The State is now emerging as a hub of HealthTourism and tourists are making a bee line to make the most of it. The blend of naturalenvirons of the State and Ayurveda, the ancient medical practice is doing wonders for thehealth of the ailing besides pepping up ones soul. The State with salubrious climes theyear round is proving to be home away from home for recuperation and rejuvenation ofthe body. The State Government is giving added priority to boost health tourism, develophealth resorts and popularise ‘Panchkarma’ to cure a number of incurable ailments. ‘Panchkarma’ is a part of the purification therapies of Ayurveda. In a literalsense, ‘Panch’ means five and ‘Karma’ means actions. It is a set of five systematicactions used for purification of the body. It brings the aggravated doshas namely vata,pitta and kapha into balance and eliminates toxins from the body. The five foldtherapeutic measures of this therapy for internal purification of body are; Vamana(controlled therapeutic emesis), Virechana (controlled therapeutic purgation);Anuvasana ( Medicated oil enema), Asthapana (medicated decotion enema) andNasya (Drug administration through nostrils). Besides treating various ailments, ‘Panchkarma’ therapy keeps ageing process atbay and improves memory and functions of all sense organs. It is very effective in themanagement of autoimmune disorders, chronic ailments like rheumatic arthritis,bronchial asthma, gastrointestinal disorders and mental diseases. Panchkarma is being injected a new lease of life in the State and the results havebeen remarkable. Egged on by the enterprising prospects of Ayurveda in the State, 12 114
  • 115. more Panchkarma centres are being opened in different parts of the state. Furthermore,Patanjali Yog Peeth, being set up near Sadhupul in Solan district would play a pivotal rolein boosting up Ayurveda in the State in particular and country in general. According toinitial projections, the Rs 50 crore project would churn out employment opportunities tonearly 1,000 locals. The State has about 4,000 health institutions out of which 1,154 are that ofayurveda, homeopathic and unani system of treatment. Ayush Medical Centres are beingset up in all Primary Health Centers, Community Health Centers and District Hospitalsunder Rural Health Mission in the State. To ensure standardized ‘Panchkarma’ services tothe people, ayurvedic professionals were sent for training to Kerala. The sector holds vastemployment and self employment prospects which could help youth in starting lucrativeventures. Congenial environs of Himachal coupled with state of the art infrastructure areattracting the health conscious. Himachal Pradesh Tourism Development Corporation(HPTDC) offers ayurvedic therapy ‘Panchkarma’ in Hotel Holiday Home, Shimla, HotelTea Bud, Palampur and Palace Hotel, Chail. At Hotel Tea-Bud, Palampur in Kangra district ‘Abhyangam’ is done prior to theprocess of ‘Panchkarma’. It increases body metabolism which leads to better tissuerespiration, increases circulation, causing the body to flush out impure materials.Abhyangam improves concentration, intelligence, confidence, soothes the skin andretains youthfulness. It helps in doing away with ‘Vata’ problems. It provides comfort tothe eyes, gives sound sleep, tones up the body, and improves muscles flexibility. 115
  • 116. ‘Netra Tarpan’ is a special treatment in which pure medicated cow’s ghee ispoured over the eyes. It is immensely beneficial in strain, refractive errors of the eyes,chronic conjunctivitis, corneal ulcer, dry eye syndrome, eye diseases due to aggravationof Vata and Pitta toxin, helps in preventing early formation of Cataract, improvesimproper co-ordination and loss of movement of the eyeballs, pain and burning sensationin the eyes. Netra Dhara is a special cleansing technique of pouring herbal extracts in acontinuous stream over the eyes. Shiro Dhara’ is best for easing fatigue, depression,mental stress, improving hair growth, memory and concentration. Similarly, Nasyam, a nasal application of herbal oil or juices is effective forparalytic and mental disorders. Ultrasonic face massage helps in increasing bloodcirculation. Kizhi Herbal Bon, another Ayurveda therapy removes toxins. This therapyproves helpful in arthritis and other muscular-skeletal diseases. Kati Vasti is a specialherbal treatment for chronic back ache and slip disc. Muttu Vasti is recommended for alltypes of joint pains. Navarkizhi is a highly effective rejuvenation massage technique which givessoothing effect to the body. It is very effective in curing Rheumatic diseases like arthritis,paralysis, hemiplegia, nervous weakness and disorders. Patra Pinda Swedan therapy isuseful in curing Osteo and Rheumatoid arthritis, injuries etc. Similarly, Shirovastitreatment is highly remedial for facial paralysis, dryness of nostrils, mouth and throat,severe headaches and other Vata-originated diseases. It is also effective for the loss oftactile sense, speech difficulties, insomnia and nervous disorders. ‘Sarvakaya Abhyangam’ therapy is done at Hotel Holiday Home, Shimla. Itlessens stress and strain, helps delay wrinkles, imparts glowing skin, and improvesflexibility of joints and mental clarity. Nalikerodakm, Kartatika Lepam is very effective 116
  • 117. in psoriasis, marks on the skin, pigmentation, arthritis, injuries and skin infections. Herbalsteam bath opens the minuscule pores of the skin eliminating toxins from the body, tonesthe skin leaving it soothe and soft. At the Palace Hotel, Chail in Solan district, Sarvakaya Abhyangam, Shirodhara,head and face massage, massage of legs and feet, head and shoulder massage, Kati vasti,Shiro Vasti, Triposha, Nalikerodakm, Karkatika Lepam and Herbal steam bath areprovided to the people. Apart from tourism undertakings, facilities for ‘Panchkarma’ treatment are alsoavailable at Rajiv Gandhi Govt. Ayurvedic Hospital, Paprola (100 Bedded), DistrictAyurvedic Hospital Bilaspur, District Ayurvedic Hospital, Dharmshala District Kangra.KANGRA HERB is also a world famous establishment in Himachal Pradesh whichproduces Herbal medicines that cure many deadly diseases like Cancer, HIV, Parkinson’s,Knee, Joints Pain, Heart, Kidney, ENT, Liver, Eye, Migraine etc. Stress problems is possible at “Kangra Herb” because it hasown cultivation of Himalayan Herbs, Organic Food, Storage, R & D,Testing, Manufacturing, Packing, Dashkarma, Herbal Hospitals, Yoga,Hawana at pollution free area near snowing peak of Himalaya in‘Kangra Valley’ of Himachal Pradesh – India under one roof. The Side effect freetreatment can save us from many Operations & Surgeries, its almost cheaper by 80% also.Kangra Herb is ‘GMP Certified’ Company holds Ayurvedic License No.HP-143-AY andFPO License No. A-847 was awarded “The Best Ayurvedic Company in the World”. 117
  • 118. 27. Case study on a project under Tourist Schemes by Himachal Tourism The tourism products / infrastructure as identified and developed in the state ofHimachal Pradesh under the scheme of “Development of Circuit Tourism and DestinationTourism” are mentioned below:1. Construction of Tourist Complex at Fagu, Shimla2. Construction of Natural Health Clinic at Tattapani,3. Tourist Complex at Kalpa4. River Rafting Facilities at Pirdi, Distt. KulluOut of these four schemes, we will discuss the following scheme which is related tohealth tourism :Construction of Natural Health Clinic at Tattapani, Mandi Tattapani is located on the bank of the river Sutlej, at an altitude of 656 m.Tattapani is approachable from Mandi via Karsog. It is also approachable via Shimla. It ispositioned in a scenic valley and surrounded by high hills, famous for its hot sulphursprings - noted for therapeutic powers. The HPTDC runs a lodge and there are several resthouses at Tattapani. The construction of baths, restaurants and natural health resort weree completedon 28.08.1999. The HPTDC has spent a total of Rs 49.63 lakh as per the details givenbelow:Table : Expenditure Break-up for the Construction WorkS. Type of Work Amount (Rs) in Lakhs.No.1 Civil work and sanitary / water supply 37.642 Electrical Installation Work 3.06 118
  • 119. 3 Miscellaneous Expenditure 8.32 0.594 Architecture fees Total 49.62 Unfortunately, the entire area was washed away in the month of August, 2000following an unprecedented flash flood due to cloudburst in Satluj River. The water of theriver went up above 40 m to 50 m from the normal level. The health clinic was alsodamaged in that flash flood and closed down. Since then no repair/ maintenance work hasbeen carried out and the product is still non functional.Table: Impact of the Project Sr. No. Type of impact Description 1 Tourist inflow 2 Employment generation Since the project is completely destroyed and non operational, its impact on tourism 3 Income generation are not assessable. 4 Social upliftmentInferences: It is very unfortunate that product got damaged within a year of itscommencement. Since then no repair work has been carried out by the concernedauthority/agency and the product is completely non functional, and therefore unable tocreate any impact on tourism of the region. 119
  • 120. 28. Health Tourism in Himachal Pradesh – SWOT AnalysisSTRENGTHS • Quality service at affordable cost • Vast pool of qualified doctors • Strong presence in advanced healthcare e.g. cardiovascular, organ transplants • High success rate in operations • International reputation of hospitals and doctors • Diversity of tourism destinations and experiences (attractions – natural & manmade) • High confidence level in Indian doctors.WEAKNESS • No strong government support /initiative to promote Health tourism • Low coordination between the various players in the industry – airline operators, hotels and hospitals and local community as well • Customer Perception as an unhygienic country • No proper accreditation and regulation system for hospitals • Lack of uniform pricing policies across hospitalsOPPORTUNITY • Increased demand for healthcare services from countries with aging population (U.S, U.K) • Fast-paced lifestyle increases demand for wellness tourism and alternative cures • Shortage of supply in National Health Systems in countries like U.K, Canada • Demand from countries with underdeveloped healthcare facilities • Demand for retirement homes for elderly people especially Japanese • Reduced competitive cost of international travelTHREATS • Strong competition from countries like Thailand, Malaysia, Singapore • Lack of international accreditation – a major inhibitor • Under-investment 120
  • 121. 29. Resources available at Himachal Pradesh for Health Tourism POSSIBILITY / AVAILABLE / NORESOURCES AVAILABLE / NOT POSSIBILITYATTRACTION / COMPETITION AVAILABLE OF DEVELOPMENT1. Natural Environment AVAILABLE -2. Climate (Warm, Low Humidity, etc.) COOL -3. Antique Curio Shops AVAILABLE -4. Geysers (Hot/Sulphur) AVAILABLE -5. Health Resorts AVAILABLE -(Traditional/Alternative – Medicine)6. Lakes/River AVAILABLE -7. Medical Experts AVAILABLE -8. Entertainment AVAILABLE -9. Beach/Pool AVAILABLE -10. Resources for Treatment AVAILABLE -(Herbs/Oils, etc.)11. Nature Walks AVAILABLE -12. Springs (Hot/Minerals) AVAILABLE -13. Treatment Practitioners AVAILABLE -14. Accommodation AVAILABLE -15. Theme Restaurant AVAILABLE -16. Water Falls AVAILABLE - Development17. Any Unique Feature Herbs / Ayurveda PossibleAbove details show that Himachal Pradesh has all the resources available that arerequired at a Health tourism destination, there is only need to discover these resourcesand to utilize them for the development of health tourism in Himachal Pradesh. 121
  • 122. 30. Recommendations Each Tourist Place in the world, whether it be Switzerland or Kerala, haveover the years developed a BRAND NAME for themselves. While Switzerland isknown for its European Splendour, Kerala is known as God’s own country. In fact,Himachal is Switzerland of India. Himachal has great scope of health tourism as itsrich natural beauty attracts tourists for health related issues. However, it requires tobe marketed smartly, especially when Uttaranchal is competing with Himachal. We should market the tourist destinations of Himachal by creating a BrandName. Brand Name emanates out of USPs (Unique Selling Points). Suggestions tocreate brand name (Brand Name Contest) could be invited from intellectuals,college students, employees from within the State. Marketing Professionals couldalso be consulted on this point. 5 to 10 minutes Film depicting the most important scenic spots; snow cladmountains; cultural heritage; popular Religious Institutions; traditional danceperformances; International Melas/festivals; Trekking Routes; Angora Farms; ShallWeaving; Apple orchards; Floriculture etc. of International Quality be produced forshowcasing the BEAUTY OF HIMACHAL. Such a Film should be screened in allthe Duty Free Shops, Air India Flights and Lounges of International Airports withinthe country as well as other Countries, where it is feasible and also in TV channelsdevoted to Travel and Tourism. A large percentage of the Tourists who come to Himachal Pradesh travel byroad following by rail and air. Although the road network in HP is by far better thanseveral other states, a Tourist enjoys only when the Road on which he is traveling isgood without any bumps. Roads are the lifelines of Tourism Industry in H.P. AllCentrally Sponsored Schemes which allow the State Govt. to secure funding fromGovt. of India for expanding the road network should be tapped. Himachal is endowed with better climatic conditions as in Europe compared toChandigarh. Nevertheless, when we travel within the Chandigarh City, we feeljoyous, mainly because of two reasons, namely, firstly, excellent roads with trafficlights and secondly, beautiful Horticultural Plants were raised at all the important 122
  • 123. Road Crossings. If Chandigarh Admn. Could do it, the Himachal Govt. can also doit. Certain important junctions where adequate space is available could beidentified and beautification could be undertaken. In case, the space is not availablein the middle of the Junction, the sideways could be opted for horticultural plants.Since the climate in Himachal is very congenial for certain plants, tourists will enjoythe scenery while driving past the road. Several Industrial Houses in H.P. wouldenjoy sponsoring such horticultural projects. All Accident-prone areas/sites should be freshly identified on thebasis of the last five years accidents and suitable guidance posts be established atappropriate places immediately for the guidance of Tourists. Several beautiful flower-bearing tree species which grow flowers indifferent seasons of the year can be grown in different parts of Himachal. They addbeauty to the Landscape. For example, such flower-bearing trees are seenoccasionally on the road between Bilaspur and Swarghat Road. Some of such important species are as under:Albizziaprocera (light green) albizzialebbec (black) sires (local name)bombaxceiba buteamonosperma (flame of the forest) jacarandaindica (blue)cassiaglauca (yellow flowers..Aug/Sept) cassiacsamea (Sept/Oct) delonexregia(orange) (List is only illustrative; Forest Dept. have a list of all such plant species) Some of the best scenic spots in Europe, where the Indian Film Directors visitfor shooting have such flower bearing trees, offering out of the world beauty for thevisiting tourists. The Horticulture Wing of Public Works Dept or the Forest Dept. should plantsuch flower bearing trees on either side of some select roads, where the touristtraffic exists. This will prove immensely attractive to the tourists. Moreover, even the Directors of Films also may be attracted to shoot suchbeautifully attractive places. 123
  • 124. A Study may be conducted about the tourist arrivals in all the important touristdestinations in the State. In fact, most of the Tourists flock to places like Shimla,Manali, Dalhousie, Dharmsala, although there exist more beautiful places inHimachal. The study should focus on the following: • Identify the virgin places in the State where Tourists could travel (In fact, tourists would like to witness Apple fruits hanging from Apple trees), such as some important/notified Orchards; Deep Forests with excellent scenic beauty; Snow Points; Lovers’ Points; • Promote facilities such as Road Network, hotels and other facilities. • Publicize such tourist destinations • Most of the Star Hotels in Mumbai and Bangalore have recently established facilities such as SPA, where the tourists release their tensions and get relaxed. In fact, Himachal is the right place for establishment of such SPAs, some of the HPTDC units should be selected for providing such SPAs. • A Band of educated unemployed could be selected from within Himachal and train them to be Excellent Professional Guides who can speak in fluent English and Hindi. Their services could be utilized by the Tourists. It is understood that presently some of the employees of HPTDC are acting as Guides from the Transport Wing. Tapping the talent from Private Sector would be desirable. • Leh in J & K is an important tourist circuit for attracting tourists to Manali; HP. Suitable packages must be developed to attract them. • Although some of the important trek routes have been identified and hosted on the Web site of Tourism Dept. yet, there is a need to take the Local People into confidence in various districts such as Kangra, Chamba, Kullu, Simla, L & S, Kinnor to identify the TRADITIONAL TREK ROUTES, which have been used by people for generations and offer them as a package to tourists. The Trekking Associations, if any, in the districts concerned needed to be consulted while formulating a package. 124
  • 125. • The Tourism Dept. in collaboration with the Dept. of Art, Language and Culture should organize “Talent Hunt” on the lines of “INDIAN IDOL” by appropriately naming the event ( Himachal ki shaan….suggestion only) and identify the best artistes of Himachal Pradesh. These best Artistes of Himachal could be exposed to the visiting Tourists in various Hotels. This will not only help in identifying the new talent and enabling them acquiring new means of livelihood, but also help promote our culture. • Some of the most important and exquisitely beautiful scenic spots like NADDI Point near Mcleodganj, Dharmasala having been located in a Panchayat area, were completely spoiled due to haphazard construction of hotels/motels. Such unregulated activity requires to be checked and planned development of hills should take place, in order to protect the fragile ecological balance. The Tourism Dept. in collaboration with Town and Country Planning Dept.should locate such places in the State for regulated and orderly development. Strategic Public and Private Partnerships with the Indian Corporate Sector forpromotion of Tourism Related Activities as already initiated by the Tourism Dept. inthe form of Tourism Conclave should be intensely followed up. The suggestions inthis regard are as under: • Invite Himachali NRIs for investment Health Tourism related projects • Non-Himachali NRIs interested in investment be encouraged. • The Business/Industrial Houses in related to Health Sector within the country who have already evinced interest in setting up their units in the State could be encouraged to adopt one or two Tourism villages. We can develop the concept of Health Tourism in Villages, based on certain criteria that may be conceived such as proximity to the main internationally known tourist attractions; access to Snow Points; access to communication including road transport; friendly and cooperative Panchayat; This will be the partnership between the community and the Corporate World. 125
  • 126. • The cost of acquiring a piece of land in Himachal is increasingly becoming prohibitively costly for even Govt. of India projects and the Private Sector also must be sharing a similar experience. Ways and means have to be developed to identify suitable lands in important tourist destinations which could be given on a reasonable cost so that Health tourism projects can be developed in the state. This aspect has to be viewed in the context of incentives being offered by Uttranchal and J & K. • A study may be conducted to ascertain from which of the countries in the world tourists are visiting India and especially Himachal Pradesh. Aggressive marketing of Himachal as a Health Tourism Destination should be done in those countries from where the tourist arrivals are substantial. The Private Tour Operators/Travel Agents in those countries may be tapped for enhancing tourist arrivals. • The Tourism Policy of a state encompasses the Transport Policy; Hospitality Policy; Health Policy; Forestry Policy; Public relations Policy and Culture Policy. At the State govt. level, there is an immense need to co-ordinate the programmes of Tourism Promotion in a concerted manner. It is, therefore, suggested that the Administrative Secretaries of all theDepartments concerned may meet periodically under the chairmanship of the worthyChief Secretary to provide the necessary impetus to tourist promotion. All Centrally Sponsored Schemes under the Ministries of Tourism, SurfaceTransport, Health, Water Resources, Rural Development, Forests should becollectively tapped for promoting tourism in the state of H.P. The tourism policyshould focus on two man made lakes namely Pong and Gobind Sagar, the formerhas already been declared a national wet land and Ramsar site for development ofadventure tourism, water sports and developing way side amusement parks andtourist villages to attract large number of tourist ready to visit from peripheraldistricts of Punjab and Union Territory of Chandigarh on week ends and vacation. 126
  • 127. 31. ConclusionsLets discuss about the health tourism in Himachal Pradesh. Both the public andprivate medical sectors of India are competing with each other to make this country thefuture leading international center for medical tourism care in the world. For the last fewdecades, India is developing its medical sector by inventing different expert technologiesof medical treatment. The rich ayurvedic knowledge and richness in Herbal resources ofHimachal Pradesh helps in the development of health and medical tourism care in India.With the development of advanced software, information technology, business servicesand outsourcing the sector of health care in India is placed at the threshold of a newtechnologically advanced era. Being a nation of extremely well educated population, India is considered as oneof the major destinations for some world-class medical treatment. Himachal Pradesh, asan excellent destination for medical & health tourism in India, provides many advancedtreatment facilities. Health tourism in Himachal Pradesh also caters some exclusive healthcare tourism packages for the foreign as well as domestic tourists. Ranging from medicalinstitutes to great research center, every medical facility can be avail in health tourism inHP. Health tourism in HP also covers several great health institutes along with advancedservices. With the increasing number of middle aged and senior citizens all the tourismproducts are targeted at these markets. An everlasting product for health tourism is thelure of youth. This tourism health product will always have takers. The trend going onshows a tilt towards alternative medical treatment and for some time to come the tilt willbe towards alternative treatment. An important factor to consider here is that although health tourism attractstourists from world over, for a country like India it’s the domestic tourists who can play amajor part in revenue generation. And, therefore, products developed should alwaysconsider them. 127
  • 128. 33. Questionnaire format: HEALTH TOURISM IN H.P (QUESTIONNAIRE FOR TOURISTS)Place:………………………Kindly render the following information in the space provided against each question.Information given by you will be used for research purpose only. Please feel free toprovide the following information given in the questionnaire.YOUR PROFILE1. Name of the Tourist ________________________________________2. Country/State ____________________________________________3. Gender: Male Female4. Age: a. Below 25 b. 25 – 40 c. Above 405. Marital Status: 1. Married 2. Un Married 128
  • 129. 6. Educational Level: 1. Matriculate 2. Graduate 3. Post Graduate 4. Others7. Occupation: 1. Services 2. Students 3. Businessman 4. Any Other8. Why do you Purpose of Visit to Himachal Pradesh?a) Religious Purpose b) Honeymoonc) Adventure Purpose d) Health Purpose9. Where did you get the information about the destination?a) Internet b) Travel Agencyc) Advertisement d) Other10. Are you a package tourist?a) Yes b) No11. You are travelling with? 1. Family 2. Friends 3. Relatives 4. Other 129
  • 130. 12. How do you rate Himachal Pradesh as a Buddhist tourism destination? c) Very Good b ) Satisfactory a) Good d) None of all13. Your mode of transportation to these places? a) Bike b) Bus c) Car d) other14. Do you think Himachal Pradesh is best destination for Buddhist Tourism? a) Agree b) Disagree c) Partially Agree d) No Idea15. Do you think that religious tourism can make a key role for economy of thestate? a) Yes b) No16. What problems did you face? a) Transportation b) Accommodation c) Food & Beverages d) Other Thanking you for your nice co-operationDate Signature…………………. …………………… 130
  • 131. 33. References a. Various medical websites b. Newspapers c. Himachal Tourism websites & reports d. India tourism websites & reports e. My mentor for this report Dr. C M Paraseera Thanks 131